پديد آورندگان :
آﺗﺸﮕﺮ، ﮐﺮﯾﻢ دانشگاه صنعتي مالك اشتر , ﻣﻮﻻﻧﺎ، ﻫﺎدي دانشگاه علوم پزشكي ارتش جمهوري اسلامي ايران , ﺑﯿﮕﻠﺮﯾﺎن، اﮐﺒﺮ دانشگاه علوم بهزيستي و توانبخشي , ﺷﯿﺦ ﻋﻠﯿﺎن، آﯾﻪ دانشگاه صنعتي مالك اشتر
چكيده فارسي :
زﻣﯿﻨﻪ و ﻫﺪف: ﺳﺮﻃﺎن ﭘﺴﺘﺎن، ﺷﺎﯾﻊ ﺗﺮﯾﻦ ﺳﺮﻃﺎن زﻧﺎن و دوﻣﯿﻦ ﻋﻠﺖ ﻣﺮگ و ﻣﯿﺮ ﻧﺎﺷﯽ از ﺳﺮﻃﺎن در زﻧﺎن ﺑﻌﺪ از ﺳﺮﻃﺎن رﯾﻪ اﺳﺖ. ﻣﺪل ﺑﻘﺎ، راﺑﻄﻪاي رﮔﺮﺳﯿﻮﻧﯽ اﺳﺖ ﮐﻪ ﻣﺸﺨﺺ ﻣﯽﮐﻨﺪ ﭼﻪ ﻋﻮاﻣﻠﯽ در ﻃﻮل ﻋﻤﺮ ﯾﮏ ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﯾﮏ ﻧﻮع ﺑﯿﻤﺎري ﺧﺎص، ﺗﺄﺛﯿﺮ ﻣﯽﮔﺬارﻧﺪ. ﻣﺪل ﺑﻘﺎي ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﭘﺴﺘﺎن را ﺑﻪ ﻋﻨﻮان ﯾﮑﯽ از ﻣﻌﯿﺎرﻫﺎي اﺻﻠﯽ ﮐﻨﺘﺮل ﺳﺮﻃﺎن و اﻧﺪازهﮔﯿﺮي ﺗﺄﺛﯿﺮ درﻣﺎن ﻣﯽﺗﻮان ﭘﺬﯾﺮﻓﺖ، ﺑﻪ ﻃﻮري ﮐﻪ ﻣﯿـﺰان ﺑﻘﺎء ﺷﺎﺧﺺ ﻣﻬﻤﯽ ﺟﻬﺖ ارزﯾﺎﺑﯽ اﺛﺮﺑﺨﺸﯽ ﺗﺸﺨﯿﺺ روش درﻣـﺎﻧﯽ و ﻣﯿﺰان ﺗﺄﺛﯿﺮ روشﻫﺎي درﻣﺎن ﺳﺮﻃﺎن ﭘﺴﺘﺎن اﺳﺖ. ﻫﺪف اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺮآورد ﺑﻘﺎي ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺳﺮﻃﺎن ﭘﺴﺘﺎن ﺑﺮ اﺳﺎس ﻣﺮاﺟﻌﻪﮐﻨﻨﺪﮔﺎن ﺑﻪ
ﺑﯿﻤﺎرﺳﺘﺎن ﺑﻌﺜﺖ ﺗﻬﺮان، ﺑﺎ اﺳﺘﻔﺎده از ﻣﺪل رﮔﺮﺳﯿﻮﻧﯽ ﮐﺎﮐﺲ اﺳﺖ.
ﻣﻮاد و روش ﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻃﻮﻟﯽ 499 ﺑﯿﻤﺎر ﺑﺎ ﺗﺸﺨﯿﺺ ﺳﺮﻃﺎن ﭘﺴﺘﺎن، ﮐﻪ ﻃﯽ ﺳﺎلﻫﺎي 1389 اﻟﯽ1394ﭘﺲ از ﻋﻤﻞ ﺟﺮاﺣﯽ، ﺗﺤﺖ درﻣﺎنﻫﺎي ﮐﻤﮑﯽ از ﻗﺒﯿﻞ ﻫﻮرﻣﻮن درﻣﺎﻧﯽ، ﺷﯿﻤﯽ درﻣﺎﻧﯽ و رادﯾﻮﺗﺮاﭘﯽ ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ، ﺑﺮرﺳﯽ ﺷﺪ و ﻣﺸﺨﺼﺎت
ﺑﺎﻟﯿﻨﯽ، درﻣﺎﻧﯽ و وﺿﻌﯿﺖ ﺑﻘﺎي آﻧﺎن ﺑﺮ اﺳﺎس ﻧﻤﻮدار ﮐﺎﭘﻼن ﻣﺎﯾﺮ و ﻣﺪل ﻣﺨﺎﻃﺮات ﮐﺎﮐﺲ ﺛﺒﺖ و ﺑﺮرﺳﯽ ﮔﺮدﯾﺪ.
ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ )± اﻧﺤﺮاف ﻣﻌﯿﺎر( ﺳﻨﯽ ﺑﯿﻤﺎران50/3 )± 11/1( ﺳﺎل ﺑﻮد. ﺷﺎﯾﻊﺗﺮﯾﻦ ﻧﻮع ﺑﺪﺧﯿﻤﯽ ﮐﺎرﺳﯿﻨﻮم ﻣﺠﺎري ﺑﺎ 88 درﺻﺪ ﻣﻮارد و 18 درﺻﺪ ﺑﯿﻤﺎران در ﻣﺮﺣﻠﻪ III ﺑﯿﻤﺎري ﻣﺮاﺟﻌﻪ ﮐﺮده ﺑﻮدﻧﺪ. ﺑﻘﺎي 2 ،1 و 5 ﺳﺎﻟﻪ ﮐﻞ ﺑﯿﻤﺎران ﺑﻪ ﺗﺮﺗﯿﺐ ﺑﺮاﺑﺮ 87، 63 و 50 درﺻﺪ ﺑﻮده اﺳﺖ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞﻫﺎي آﻣﺎري ﻧﺸﺎن داد ﮐﻪ ﺳﻦ، اﻧﺪازه ﺗﻮﻣﻮر، وﺟﻮد ﻣﺘﺎﺳﺘﺎز در زﻣﺎن ﺗﺸﺨﯿﺺ و ﻫﻮرﻣﻮن درﻣﺎﻧﯽ ﮐﻪ ﺑﻪ وﺿﻌﯿﺖ رﺳﭙﺘﻮري واﺑﺴﺘﻪ اﺳﺖ، راﺑﻄﻪ ﻣﻌﻨﯽداري ﺑﺎ ﻣﺨﺎﻃﺮه ﻣﺮگ اﯾﻦ ﺑﯿﻤﺎران دارد. ﻟﺬا ﻣﺪل ﺑﻘﺎء رﮔﺮﺳﯿﻮن ﮐﺎﮐﺲ در اﯾﻦ
ﻣﻄﺎﻟﻌﻪ، ﺑﺮ اﺳﺎس اﯾﻦ ﻣﺘﻐﯿﺮﻫﺎ ﭘﯿﺸﻨﻬﺎد و ﺗﺤﻠﯿﻞ ﺑﻘﺎي ﺑﯿﻤﺎران ﺑﺮ اﯾﻦ اﺳﺎس اﻧﺠﺎم ﺷﺪ.
ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: اﺣﺘﻤﺎل ﺑﻘﺎء ﺑﺎ اﻓﺰاﯾﺶ ﺳﻦ ﮐﺎﻫﺶ ﻣﯽﯾﺎﺑﺪ. اﯾﻦ ﮐﺎﻫﺶ ﺑﺮاي ﮔﺮوه ﺳﻨﯽ ﺑﺎﻻﺗﺮ از 75 ﺳﺎل )ﮐﺎﻫﺶ 55%( ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ اﺳﺖ. اﯾﻦ ﭘﮋوﻫﺶ ﻧﺸﺎن ﻣﯽدﻫﺪ ﮐﻪ ﺧﻄﺮ ﻣﺮگ در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﺗﺤﺖ ﻫﻮرﻣﻮن درﻣﺎﻧﯽ ﻗﺮار ﮔﺮﻓﺘﻪاﻧﺪ، ﺑﺴﯿﺎر ﮐﻤﺘﺮ از ﺑﯿﻤﺎراﻧﯽ اﺳﺖ ﮐﻪ ﻫﻮرﻣﻮن اﺳﺘﺮوژن درﯾﺎﻓﺖ ﻧﮑﺮدهاﻧﺪ، زﯾﺮا ﺑﯿﻤﺎراﻧﯽ ﮐﻪ ﻫﻮرﻣﻮن درﻣﺎﻧﯽ ﺷﺪﻧﺪ، داراي ﮔﯿﺮﻧﺪه اﺳﺘﺮوژن و ﭘﺮوژﺳﺘﺮون ﻣﺜﺒﺖ ﺑﻮدهاﻧﺪ ﮐﻪ ﭘﯿﺶ آﮔﻬﯽ ﻣﻨﺎﺳﺒﯽ ﺑﺮاي اﯾﻦ ﺑﯿﻤﺎري اﺳﺖ. ﻫﻤﭽﻨﯿﻦ اﮔﺮ ﺑﯿﻤﺎران در ﻣﺮاﺣﻞ اﺑﺘﺪاﯾﯽ ﺑﯿﻤﺎري و ﺑﺪون ﻏﺪد ﻟﻨﻔﺎوي درﮔﯿﺮ، ﺷﻨﺎﺳﺎﯾﯽ ﺷﻮﻧﺪ و درﻣﺎن ﻣﻨﺎﺳﺐ درﯾﺎﻓﺖ ﮐﻨﻨﺪ، ﻃﻮل ﻋﻤﺮ ﺑﯿﺸﺘﺮي ﺧﻮاﻫﻨﺪ داﺷﺖ. ﻟﺬا آﻣﻮزش ﺑﻪ ﺧﺎﻧﻢﻫﺎ در ﺟﻬﺖ ﺷﻨﺎﺳﺎﯾﯽ ﺳﺮﻃﺎن ﭘﺴﺘﺎن در ﻣﺮاﺣﻞ اوﻟﯿﻪ، ﺑﺎﯾﺪ ﺑﺎ ﺟﺪﯾﺖ ﺑﯿﺸﺘﺮي ﺗﻮﺳﻂ ﻣﺮاﮐﺰ ﺑﻬﺪاﺷﺘﯽ دﻧﺒﺎل ﺷﻮد.
چكيده لاتين :
Introduction & Objective: Breast cancer is the most common cancer in women and the second leading cause of cancer related mortality after lung cancer. Survival models, a regression equation that determines what the life of a patient with a particular disease affects. The survival of patients with breast cancer as one of the main criteria to measure the impact of cancer control and treatment can be accepted. So that the survival rate is an important indicator to assess the effectiveness of diagnosis and the treatment effect of breast cancer treatment. The aim of this study was to determine the survival rate of patients with breast cancer who referred to hospital by air force mission of the Islamic Republic, using a Cox regression model.
Materials & Methods: In this longitudinal study of 499 patients with breast cancer during the years 1389 to 1394 after surgery, treatment aids such as hormone therapy, chemotherapy and radiotherapy had been investigated, and clinical characteristics, treatment and condition of their survival were recorded.
Results: The mean age (± SD) of patients was 3.50 (± 1.11) years. The most common type of malignancy were invasive duct carcinoma by 88% and 18% of patients with stage III disease had been admitted. One, two and five -year survival of the patient was 87%, 63% and 50%, respectively. Statistical analysis showed that age, tumor size, metastasis and hormone therapy was a significant relationship with the risk of death in these patients, so Cox regression survival model in this study, based on this proposal, and survival analysis based on it is done.
Conclusions: Survival following diagnosis of cancer has decreased with the increasing of age groups. The decreasing rate for age group of 75+ is noticeable. This study shows that the risk of death in patients who undergo hormone therapy are much lower than patients who were not able to hormone therapy because patients who were treated with testosterone, estrogen and progesterone receptors were positive prognosis for this disease. As well as patients who have lymph nodes involved in the early stages of the disease were identified and receive appropriate treatment, life will be more. Therefore, education to early diagnosis of breast cancer in women must be considered and followed seriously
