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Socioeconomic and clinical factors affecting the proportion of breast conserving surgery in Chinese women with breast cancer.

Background
This study investigated the socioeconomic and clinical factors affecting the proportion of breast conserving surgery (BCS) in China, to improve the proportion and success rate of BCS in Chinese breast cancer patients.


Methods
Six hundred and forty breast cancer patients treated with BCS were compared with 700 selected breast cancer patients (controls) treated with modified radical mastectomy (MRM) in Tianjin Medical University Cancer Institute and Hospital from January 2005 to January 2018. Patients' socioeconomic and clinical factors were collected through telephone interviews or face-to-face interviews. A total of 5,660 BCS patients were enrolled to analyze independent factors affecting initial positive margins. Chi-squared test and multiple logistic regressions were used to examine factors associated with BCS. The locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using the Kaplan-Meier method and the survival distribution between BCS and MRM groups was compared by log-rank test.


Results
Breast cancer patients who were younger, lived in urban areas, had medical insurance, and higher levels of education and Personal income were more likely to choose BCS. We also observed that patients of Han nationality were more likely to choose BCS. Univariate analysis showed that the frozen section analysis (FSA) positive margin was significantly correlated with tumor distance from the nipple, preoperative magnetic resonance imaging (MRI) examination, T stage, pathological subtype, and lymphovascular invasion (LVI). Multivariate analysis showed the distance from the nipple, T stage, pathological subtype, and LVI, and no preoperative MRI examination were independent predictors of positive resection margins. Multivariate analysis of the correlation between MRI findings and positive resection margins revealed that tumor size, non-mass enhancement (NME), and malignant enhancement surrounding the tumor were independent predictors of positive resection margins.


Conclusions
In China, socioeconomic factors largely influence the choice of surgical procedures for breast cancer patients. A gradual reduction in the influence of socioeconomic factors on the proportion of BCS is recommended. Furthermore, preoperative MRI should be encouraged in patients preparing for BCS. Clinicopathological characteristics and MRI findings are significantly associated with a positive resection margin in breast cancer patients.