2021-2022年河南省乳腺癌临床TNM分期评估情况及影响因素分析  

Clinical TNM staging assessment and influencing factors analysis of breast cancer 2021-2022 in Henan Province

作　　者：王芳 陈秀春 常靖 杨淑敏 乔江华 刘真真 WANG fang;CHEN Xiuchun;CHANG jing;YANG Shumin;QIAO Jianghua;LIU Zhenzhen(The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou,Henan 450008,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院乳腺科),河南省乳腺癌诊疗中心,河南郑州450008 [2]郑州大学附属肿瘤医院(河南省肿瘤医院医务部),河南省乳腺癌诊疗中心,河南郑州450008

出　　处：《中华肿瘤防治杂志》2025年第3期139-143,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：河南省中青年卫生健康科技创新领军人才培养(YXKC2022005)。

摘　　要：目的 探讨2021-01-01-2022-12-31河南省28家医院乳腺癌患者的临床TNM分期评估情况及影响因素,为进一步规范乳腺癌诊疗提供方法和依据。方法 2023年4-5月通过问卷调查收集河南省199家开展乳腺癌诊疗工作的二级以上医疗机构的自查结果,经数据整理与统计分析后筛选出28家医院,抽查各医院24份病历,对首次治疗前临床TNM分期诊断和检查评估策略符合情况进行检查,比较采用χ^(2)检验,将影响乳腺癌临床TNM分期诊断率和检查评估策略符合率的因素纳入多因素logistic回归模型,计算相应因素OR及95%CI。结果 共检查病历672份。三级医院占92.85%,二级医院占7.14%;乳腺专科占78.57%,非乳腺专科占21.43%。单因素分析结果显示,三级医院的临床TNM分期诊断率(84.29%)高于二级医院(29.17%),乳腺专科的临床TNM分期诊断率(84.85%)高于非乳腺专科(63.89%),差异有统计学意义,均P<0.001;三级医院的临床TNM分期检查评估策略符合率(96.63%)高于二级医院(45.83%),乳腺专科的临床TNM分期检查评估策略符合率(96.97%)高于非乳腺专科(78.47%),差异有统计学意义,均P<0.001。多因素分析结果显示,医院级别(χ^(2)=47.353,P<0.001)和科室类型(χ^(2)=15.894,P<0.001)是临床TNM分期诊断率的独立影响因素;医院级别(χ^(2)=69.570,P<0.001)和科室类型(χ^(2)=26.870,P<0.001)也是临床TNM分期检查评估策略符合率的独立影响因素。结论 低级别医院和非乳腺专科医院的乳腺癌临床TNM分期评估情况仍不理想,下一步应建立强制评估措施,加强TNM分期专项培训,提高电子病历信息化水平,从而提高临床TNM分期评估率,实现乳腺癌诊疗的规范化和同质化。Objective To explore the clinical TNM staging assessment and influencing factors of breast cancer patients in 28 hospitals in Henan Province from January 1,2022 to December 31,2021,so as to provide methods and basis for further standardizing the diagnosis and treatment of breast cancer.Methods The self-examination results of 199 secondary or higher medical institutions in breast cancer diagnosis and treatment in Henan Province were collected through questionnaire survey from April to May 2023.After data sorting and statistical analysis,28 hospitals were selected,24 medical records of each hospital were selected,and the compliance of clinical TNM staging diagnosis and inspection and evaluation strategy before the first treatment was checked.The χ^(2) test was used for comparison.The factors affecting the clinical TNM staging diagnosis rate and inspection and evaluation strategy compliance rate of breast cancer were included in the multi factor logistic regression model,and the odds ratio(OR) and 95% confidence interval(95%CI) of the corresponding factors were calculated.Results A total of 672 medical records were examined.The tertiary hospitals accounted for 92.85%,and the secondary hospitals accounted for 7.14%.The breast department accounted for 78.57%,non-breast department accounted for 21.43%.Univariate analysis showed that the clinical TNM stage diagnosis rate in tertiary hospitals was higher than that in secondary hospitals,84.29% and 29.17%,respectively.The clinical TNM stage diagnosis rate in breast department was higher than that in non-breast department,84.85% and 63.89%,respectively,with significant statistic(P<0.001).The coincidence rate of TNM staging examination assessment strategy in tertiary hospitals was higher than that in secondary hospitals(96.63% and 45.83%,respectively),and the coincidence rate of TNM staging examination assessment strategy in breast department was higher than that in non-breast department(96.97%and 78.47%,respectively),with significant statistic(P<0.001).Multivariate analys

关 键 词：乳腺癌 TNM分期 诊断率 符合率 规范诊疗 河南省 

分 类 号：R737.9[医药卫生—肿瘤]