{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:34:37Z","timestamp":1760834077104,"version":"build-2065373602"},"reference-count":46,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82271650","82303552"],"award-info":[{"award-number":["82271650","82303552"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Natural Science Youth Science Foundation Project","award":["82102865"],"award-info":[{"award-number":["82102865"]}]},{"name":"Guangdong Science and Technology Department","award":["2020B1212060018"],"award-info":[{"award-number":["2020B1212060018"]}]},{"name":"Guangzhou Science Technology and Innovation Commission","award":["202102010221","20212200003"],"award-info":[{"award-number":["202102010221","20212200003"]}]},{"DOI":"10.13039\/501100010841","name":"Guangdong Provincial Development and Reform Commission","doi-asserted-by":"publisher","award":["4250022021"],"award-info":[{"award-number":["4250022021"]}],"id":[{"id":"10.13039\/501100010841","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Hospital Administration","award":["RXDBZ-2022-04"],"award-info":[{"award-number":["RXDBZ-2022-04"]}]},{"name":"The Sun Yat-Sen University Clinical Research 5010 Program","award":["#2018022, Recipient: Kai Chen"],"award-info":[{"award-number":["#2018022, Recipient: Kai Chen"]}]},{"name":"The Yat-sen Scholarship of Young Scientist program of Sun Yat-sen Memorial Hospital, Sun Yat-sen University","award":["Recipient: Kai Chen"],"award-info":[{"award-number":["Recipient: Kai Chen"]}]},{"name":"The Sun Yat-sen Clinical Research Cultivating Program of Sun Yat-sen Memorial Hospital, Sun Yat-sen University","award":["#SYS-Q-202002 Recipient: LZ"],"award-info":[{"award-number":["#SYS-Q-202002 Recipient: LZ"]}]},{"name":"The China Anti-aging Promoting Association","award":["Recipient: SL"],"award-info":[{"award-number":["Recipient: SL"]}]},{"name":"National Natural Science Foundation of Guangdong Province","award":["2019A1515011467","2019A1515110075","2021A1515012361"],"award-info":[{"award-number":["2019A1515011467","2019A1515110075","2021A1515012361"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,13]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Our study aims to evaluate the spatial and temporal changes of breast-conserving surgery (BCS) rates and influential factors of BCS in Guangdong Province, China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design, setting and participants<\/jats:title>\n                  <jats:p>This registry-based cohort study analysed the data of patients of all age groups, from the medical record cover page, which was mandatorily collected for inpatients by the Health Administrative Department of Guangdong Province, China. Patients with non-metastatic breast cancer, who underwent breast surgery between 2013 and 2019, were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcomes and measures<\/jats:title>\n                  <jats:p>We analysed the BCS rate in Guangdong Province between 2013 and 2019. Logistic regression was applied to investigate the association between patient-level influential factors and BCS, respectively. We used restricted cubic spline regression to model the non-linear association between hospital volume rank with BCS rate. Linear regression was used to evaluate the association between city-level parameters with BCS rate of each city.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 93 521 patients with non-metastatic breast cancer, who underwent breast surgery, were included in the analyses. Among them, 10 949 (11.7%) had BCS, with the BCS rates increasing from 0.8% in 2013 to 19.2% in 2019. Patients who were older (vs &lt;40 years, 40\u201349 years: adjusted OR 0.72, 95%\u2009CI 0.68 to 0.76; 50\u201359 years: 0.51, 95%\u2009CI 0.48 to 0.54; \u226560 years: 0.37, 95%\u2009CI 0.35 to 0.40) and married (vs unmarried, 0.64, 95%\u2009CI 0.59 to 0.70) were less likely to undergo BCS. Patients who were employed (vs unemployed, 1.58, 95%\u2009CI 1.49 to 1.68), received cross-city surgery (vs local surgery, 1.37, 95%\u2009CI 1.31 to 1.44), lived in a high-income city (vs low-income city, \u03b2=4.40, 95% CI 1.55 to 7.24) or in a city with a higher number of physicians per 100 000 residents (0.57, 95%\u2009CI 0.31 to 0.82) were more likely to receive BCS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions and relevance<\/jats:title>\n                  <jats:p>This study suggests a significant increase in BCS rates from 2013 to 2019 in Guangdong, China. Promotion of BCS is needed, particularly among older patients, lower-volume hospitals and economically underdeveloped areas. Healthcare system should be prepared to support the increased awareness of seeking BCS among younger patients with breast cancer by improving the availability of radiotherapy, multidisciplinary team and patients\u2019 education programme.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-089188","type":"journal-article","created":{"date-parts":[[2025,2,2]],"date-time":"2025-02-02T20:50:41Z","timestamp":1738529441000},"page":"e089188","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial and temporal changes of breast-conserving surgery rates and its influential factors among Chinese patients with breast cancer from 2013 to 2019: a registry-based study"],"prefix":"10.1136","volume":"15","author":[{"given":"Queran","family":"Lin","sequence":"first","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China"},{"name":"Artificial intelligence lab, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China"},{"name":"Clinical Research Design Division, Clinical Research Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunrong","family":"Li","sequence":"additional","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tongrui","family":"Shang","sequence":"additional","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiujuan","family":"Gui","sequence":"additional","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Breast Tumour Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. 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