目的

比较乳腺癌保留乳房和乳房全切手术患者的生活质量。

方法

回顾性收集首都医科大学宣武医院普通外科2006 年1 月至2013 年12 月间,由同一组手术医师连续完成的保留乳房或乳房切除手术的乳腺癌患者资料,按照入组和排除标准筛选出符合入组条件患者232 例,使用欧洲癌症治疗研究组织(EORTC)制定的测量癌症患者生活质量量表(QLQ)-C30 和QLQ-BR23 对其生活质量进行评价。 于2014 年2 月至2015 年4 月调查期间,发放并回收生活质量调查问卷207 份,分为保留乳房组(101 例)和乳房全切组(106 例)。 两组患者腋窝手术方式、化疗、放射治疗、内分泌治疗、文化程度等计数资料的比较采用χ² 检验,肿瘤分期差异采用Z 检验,生活质量数据差异采用t 检验比较。

结果

问卷回收率为89%(207/232)。 对比两组患者一般资料,结果显示,保留乳房组和乳房全切组在肿瘤分期、腋窝淋巴结手术情况、化疗、内分泌治疗情况等差异均无统计学意义(Z=-1.925,χ² =5.129、0.121、1.943,P 均＞0.050),但保留乳房组的放射治疗比例明显高于乳房全切组[91.1%(92/101)比28.3%(30/106),χ²=84.248 ,P＜0.001],且文化程度高者(高中及以上学历)占80.2%(81/101),显著高于乳房全切组的60.3%(64/106)(χ²=9.684,P=0.017)。 QLQ-C30 结果显示,两组患者在总体生活质量、躯体功能、角色功能、情绪功能、认知功能、社会功能领域及疲乏、恶心与呕吐、疼痛、呼吸困难、睡眠障碍、食欲、便秘、腹泻、经济困难等子量表的评分差异均无统计学意义(t=0.456、2.297、2.106、-1.529、-0.400、0.689、-1.050、0.354、-1.219、-0.473、1.027、-0.118、0.623、0.179、-1.066,P 均＞0.050)。QLQ-BR23 结果显示,保留乳房组患者的体象评分(83.2±19.6)显著高于全切组( 66.2±20.1)(t=4.854,P＜0.001),在性功能、性欲、对未来的憧憬、系统治疗不良反应、乳房症状、上肢症状和对脱发的担忧方面评分组间差异均无统计学意义(t=-0.628、-0.874、-0.418、0.000、-0.193、-0.457、0.774,P 均＞0.050)。

结论

保留乳房手术患者总体生活质量与乳房全切组没有差异,但保留乳房手术能很好的维护患者的体象,即患者体形满意度明显高于乳房切除组,所以保留乳房手术仍值得进一步推广。

Objective

To compare the quality of life in breast cancer patients receiving breast conserving surgery and the patients receiving mastectomy.

Methods

Totally 232 breast cancer patients who underwent either breast conserving surgery or mastectomy by the same group of doctors in Department of General Surgery, Xuanwu Hospital from January 2006 to December 2013 were involved according to the incision criteria. Quality of life was evaluated based on the European Organization for Research and Treatment of Cancer(EORTC) quality of life questionnaire C30 (QLQ-C30) and QLQ-BR23. From February 2014 to April 2015,a total of 207 patients completed the questionnaires and were divided into two groups:101 patients treated with breast conserving surgery and 106 with mastectomy. χ² test was used to compare the count data including axillary surgery, chemotherapy, radiotherapy, endocrine therapy and educational level. Z test was used for tumor staging data and t test was used to analyze the quality of life between two groups.

Results

The recovery rate of questionnaires was 89% (207/232). There was no significant difference in tumor stage, axillary surgery, chemotherapy and endocrine therapy between two groups(Z=-1.925,χ²=5.129,0.121,1.943; all P＞0.050). The percentage of patients receiving radiotherapy in breast conserving surgery group (91.1%,92/101) was significantly higher than that in mastectomy group (28.3%,30/106) (χ²=84.248, P＜0.001).The patients with high educational level (high school and above) accounted for 80.2% (81/101) in breast conserving surgery group, which was significantly higher than 60.3% (64/106) in mastectomy group (χ² =9.684,P=0.002). The results of QLQ-C30 showed that the scores of overall quality of life, physical function,role function, emotional function, cognitive function, social function, fatigue, nausea and vomiting, pain,dyspnoea, insomnia, appetite loss, constipation, diarrhoea and financial difficulty were not significantly different between two groups (t=0.456,2.297,2.106, -1.529, -0.400,0.689, -1.050,0.354, -1.219,-0.473,1.027, -0.118, 0.623, 0.179, -1.066, all P＞0.050). In QLQ-BR23, the patients in breast conserving surgery group showed a better body image(83.2±19.6 ) compared with mastectomy group (66.2±20.1) (t=4.854, P＜0.001). There were no significant differences in sexual functioning, sexual desire,future perspective, adverse reaction of systemic therapy, breast symptoms, upper extremity symptoms and anxiety caused by hair loss between two groups (t= -0.628, -0.874, -0.418, 0.000, -0.193, -0.457,0.774, all P＞0.050).

Conclusion

Patients with breast conserving surgery have a better body image than patients with mastectomy do, with no statistical difference in quality of life, worthy of clinical application.