PURPOSE Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients' refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. METHODS A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan-Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. RESULTS About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001). CONCLUSIONS All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients' refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.

中文翻译：

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患者拒绝接受辅助治疗措施对生存的影响。

目的 乳腺癌患者接受多学科肿瘤委员会的治疗建议。为了确定患者拒绝此类建议的后果，我们分析了德国奥芬堡 Ortenau 诊所乳腺癌中心的数据库。方法 对 1997 年至 2019 年间接受治疗的 4315 名非转移性原发性乳腺癌患者进行描述性分析、Kaplan-Meier 生存分析和 Cox 回归分析，分析拒绝治疗的影响。结果 约10.7%的患者拒绝治疗建议。这些显着老年人（F = 74.4；p < 0.001；单向方差分析），具有更大的肿瘤大小（F = 36.7；p < 0.001；单向方差分析），受累淋巴结数量更多（F = 4.2； p = .039；单向方差分析），和更多分化较差的肿瘤（χ2 = 16.8；df = 2；p < 0.001）。拒绝辅助治疗导致局部复发率较高（χ2 放疗 = 109.1；df = 1；p < 0.001，χ2 化疗 = 18.3；df = 1；p < 0.001，χ2 内分泌 = 32.5；df = 1；p <）较差的总生存率（χ2 放疗 = 184.9；df = 6；p < 0.001；χ2 化疗 = 191.8；df = 6；p < 0.001）。结论 乳腺癌辅助治疗的所有部分都与无病生存率和总生存率的改善明显相关。要回答有关患者拒绝背景的开放性问题，似乎有必要对前瞻性数据收集进行分析。此外，