| Abstract | CILJ ISTRAŽIVANJA: Osnovni cilj ovog istraživanja bio je utvrditi razliku u vrsti liječenja bolesnica oboljelih od karcinoma dojke u odnosu na vrstu ustanove u kojoj su liječene te utvrditi povezanost između veličine tumora i imunofenotipa, fokalnosti, histološkog podtipa, gradusa tumora te zahvaćenosti limfnih čvorova.
MATERIJALI I METODE: U istraživanje su uključeni bolesnici kojima je karcinom dojke dijagnosticiran u Republici Hrvatskoj u 2017. godini. Uvidom u medicinsku dokumentaciju dobiveni su podaci o dobi bolesnika, veličini tumora, histološkom tipu, gradusu, fokalnosti, bilateralnosti, statusu hormonskih receptora, HER 2 statusu, proliferacijskom indeksu, imunofenotipu, kliničkom stadiju, te primijenjenom kirurškom i onkološkom liječenju. Ustanove smo razdvojili u dvije skupine, u prvu skupinu ustanova uvrstili smo kliničke bolničke centre i kliničke bolnice, a u drugu opće i županijske bolnice te poliklinike.
REZULTATI: U Republici Hrvatskoj u 2017. godini registrirano je 2613 bolesnika oboljelih od karcinomoma dojke. Od 2613 oboljelih, u prvoj skupini ustanova liječeno je 1974 (75,5%) bolesnika, a u drugoj skupini ustanova liječeno je 639 (24,5%) bolesnika. Vrsta liječenja statistički se značajno razlikovala u odnosu na skupine ustanova (P<0,001), u manjim ustanovama je značajno veći udio kompletno operiranih bolesnika, za razliku od većih ustanova, gdje je zabilježen veći udio neoadjuvantno liječenih. Zabilježena je statistički značajna razlika razdiobe nodalnih disekcija između većih i manjih ustanova (P<0,001) te je disekcija aksile značajno češće rađena u manjim ustanovama, dok je u većim ustanovama češće rađena sentinel nodalna biopsija. Postoji statistički značajna razlika razdiobe kliničkih stadija prema skupini ustanova (P=0,001) te je udio tumora kliničkog stadija IA i IB značajno veći u većim ustanovama u odnosu na manje ustanove. Medijan veličine tumora na razini Hrvatske iznosio je 1,7 cm, te je zabilježena statistički značajna razlika veličine tumora u odnosu na fokalnost (P<0,001), histološki tip (P=0,012), gradus (P<0,001) te tip nodalne disekcije (P<0,001).
ZAKLJUČCI: Osobitosti karcinoma dojke u Republici Hrvatskoj u skladu su s osobitostima karcinoma dojke u Europi i svijetu, ali način liječenja razlikovao se s obzirom na vrstu ustanova. Postoje brojni segmenti na kojima treba raditi kako bi se postigli optimalni rezultati u prevenciji, dijagnostici i liječenju karcinoma dojke, uz osnivanje specijaliziranih centara u kojima bi se obavljalo dijagnosticiranje, liječenje, praćenje i istraživanje karcinoma dojke. |
| Abstract (english) | OBJECTIVES: The main purpose of this study was to determine the difference between types of breast cancer treatment in commparison to the type of medical institution they were treated in and to determine the connection between the size of the tumor and immunophenotype, focality, histological subtype, grade and lymph node positivity.
PATIENTS AND METHODS: This study included patients diagnosed with breast cancer in Croatia in the period from January 1st 2017. till December 31st 2017. Clinical data was obtained from the medical documentation regarding the patient age, tumor size, histological type, tumor grade, focality, bilaterality, hormone receptor status, HER2 status, proliferation index, immunophenotype, clinical stage and the surgical and oncological treatment. We divided the institutions in two groups, the first group included University hospitals and clinical hospitals and the second group included county hospitals, general hospitals and polyclinics.
RESULTS: 2613 patients with breast cancer were registered in 2017 in Croatia. Out of 2613 patients, 1974 (75,5%) patients were treated in the first group of institutions and 639 (24,5%) patients were treated in the second group of institutions. The type of treatment was statistically different in comparison to the type of institution (P<0,001), there was significantly more completely operated patients in smaller institutions and significantly more neoadjuvantally treated patients in large institutions. Nodal dissection was performed significantly more often in smaller institutions, while sentinel lymph node biopsy was more often performed in large institutions. Also, the share of tumors in stages IA and IB was significantly bigger in large institutions. Median of size of the tumor in Croatia was 1,7 cm, and statistically significant difference was found regarding the focality (P<0,001), histological type (P=0,012), grade (P<0,001) and the type of nodal dissection (P<0,001).
CONCLUSION: Breast cancer characteristics in Croatia are in concordance with breast cancer characteristics in Europe and the rest of the world, but the type of treatment was different regarding the type of medical institution. There are multiple segments that need to be worked on to achieve optimal results in breast cancer prevention, diagnostics and treatment, with forming specialized centers where diagnostics, treatment, follow – up and research of breast cancer would be combined. |
