RESUMEN
Breast reconstruction (BR) should be offered and discussed to each woman with breast cancer who planned for mastectomy, except the cases with severe comorbidities. However, the majority of these patients do not undergo reconstructive surgery. A 20-question survey was administered to a group of 50 women (age 29-83 years, median 53) treated with mastectomy. 22.4 % underwent reconstruction of the breast, 24.5 % declared an interest in BR in the future, 53.1 % were not interested in reconstructive surgery. 51.2 % obtained information concerning BR before surgery, 58.1 % after and 44.2 % both before and after mastectomy. 59.2 % were informed about reimbursement. Information given before surgery had a statistically significant impact on performing reconstruction or a declared interest in BR (X 2 = 4.950, df = 1, p < 0.05), as well as information about reimbursement (X 2 = 8.875, df = 1, p < 0.05). Age <55 years was another significant factor (X 2 = 13.522, df = 1, p < 0.05, C Pearson = 0.525). Level of education did not impact upon the choice (p > 0.05). The main reasons for the refusal were fear of complications (47.4 %), priority to recovery over aesthetic (36.8 %), age, defined by the patient as "advanced" (31.6 %), high level of acceptance of the body after amputation (31.6 %), fear of cancer recurrence (26.3 %) and fear of the pain and discomfort (15.8 %). Each patient who planned for mastectomy should obtain sufficient information regarding breast reconstruction. Exact information is of special benefit to women discouraged by imagined disadvantages of surgery. Patients' education impacts the quality of life-not only before surgery but also lifelong after finishing the treatment.
Asunto(s)
Neoplasias de la Mama/cirugía , Mamoplastia , Mastectomía/rehabilitación , Educación del Paciente como Asunto , Conducta de Elección , Miedo , Femenino , Humanos , Persona de Mediana Edad , Calidad de Vida , Encuestas y CuestionariosRESUMEN
PURPOSE: The aim of this study was to determine the values of Ki-67 antigen, oncoprotein Her2/neu and laminin, as prognostic and predictive factors in NSCLC, and on the basis of these markers to create a prognostic model which would make it possible to identify patients with a high risk of disease recurrence. MATERIAL AND METHODS: The material for the study came from 64 patients with NSCLC, who underwent surgery in Dolnoslaskie Centrum Gruzlicy i Chorób Pluc i 1996-2000, and subsequently were given radiation therapy in Dolnoslaskie Centrum Onkologii. RESULTS: Among the markers researched, a high level of (intracellular) laminin in carcinoma cells was found to be an unfavourable prognostic factor. Also, another group of patients with an overexpression of oncoprotein Her2/neu were found to have a poorer prognosis, although the influence of proliferative index Ki-67 on patient survival could not be explained. The prognostic model LAMHER, which was defined on the basis of the intracellular laminin level and expression HER2/neu, enables the identification of a group of patients with a high risk of disease recurrence. In a multidimensional analysis of the "classification tree", it was found that patients with the highest risk of disease recurrence were those with LAMHER = 1 (overexpression Her2/neu and/or a high level of intracellular laminin), and patients with LAMHER = 0 but a Fractionation Dilution Factor higher than 1.57. CONCLUSIONS: The conclusion of this study is that multiple molecular marker testing is necessary to detect an independent prognostic impact on survival and is therefore superior to single marker testing. Based on LAMHER testing, two groups of patients could be defined: a low-risk group (LAMHER = 0) and a high-risk group (LAMHER = 1) for failure of standardized treatment.