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Going beyond costs when evaluating surgical options for women newly diagnosed with breast cancer.在评估新诊断出乳腺癌的女性的手术选择时，要超越成本因素。
Med Care. 2001 Nov;39(11):1143-5. doi: 10.1097/00005650-200111000-00001.
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J Clin Oncol. 2001 Apr 15;19(8):2254-62. doi: 10.1200/JCO.2001.19.8.2254.
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Surgical treatment of early-stage breast cancer in the Department of Defense Healthcare System.国防部医疗系统中早期乳腺癌的外科治疗
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Measuring and predicting surgeons' practice styles for breast cancer treatment in older women.测量和预测老年女性乳腺癌治疗中外科医生的执业风格。
Med Care. 2001 Mar;39(3):228-42. doi: 10.1097/00005650-200103000-00004.
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Factors influencing choice between mastectomy and lumpectomy for women in the Carolinas.
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Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy.影响女性选择保乳手术而非改良根治性乳房切除术的因素。
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早期乳腺癌保乳手术的应用是否不足？来自爱荷华州II期患者的工具变量证据。

Was breast conserving surgery underutilized for early stage breast cancer? Instrumental variables evidence for stage II patients from Iowa.

作者信息

Brooks John M, Chrischilles Elizabeth A, Scott Shane D, Chen-Hardee Shari S

机构信息

Health Effectiveness Research Center, College of Pharmacy and the College of Public Health, University of Iowa, Iowa City 52242, USA.

出版信息

Health Serv Res. 2003 Dec;38(6 Pt 1):1385-402. doi: 10.1111/j.1475-6773.2003.00184.x.

DOI:10.1111/j.1475-6773.2003.00184.x
PMID:14727779
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1360955/
Abstract

OBJECTIVE

To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989-1994. DATA SOURCES/DATA SETTING: Secondary linked Iowa SEER Cancer Registry--Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989-1994.

STUDY DESIGN

Observational instrumental variables (IV) analysis.

DATA COLLECTION/EXTRACTION METHODS: Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989-1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts.

PRINCIPAL FINDINGS

Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities.

CONCLUSIONS

If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.

摘要

目的

评估1989 - 1994年爱荷华州边缘性II期乳腺癌患者保乳手术加放疗相对于乳房切除术的平均生存效果。数据来源/数据集：爱荷华州SEER癌症登记处与爱荷华州医院协会出院摘要数据的二次关联，数据涉及1989 - 1994年爱荷华州患有II期乳腺癌的女性。

研究设计

观察性工具变量（IV）分析。

数据收集/提取方法：1989 - 1994年爱荷华州SEER癌症登记处患有II期乳腺癌且在爱荷华州接受所有住院治疗的女性与各自的医院出院摘要相关联。

主要发现

20世纪90年代初，对于爱荷华州边缘性II期乳腺癌患者，保乳手术加放疗相对于乳房切除术降低了生存率。在本研究中，边缘患者是那些手术选择受地区治疗率差异和放疗设施可及性影响的患者。

结论

如果边缘患者代表其治疗选择会受治疗率变化影响的患者，那么20世纪90年代初爱荷华州II期早期乳腺癌患者保乳手术加放疗率的增加会降低生存率。需要用更新的数据和更广泛的样本进行进一步研究，以做出更具时效性和针对性的评估。