导管原位癌或早期浸润性乳腺癌女性患者放疗不足的相关因素及影响
Correlates and effect of suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer.
作者信息
Gold Heather Taffet, Do Huong T, Dick Andrew W
机构信息
Weill Cornell Medical College, New York, New York 10021, USA.
出版信息
Cancer. 2008 Dec 1;113(11):3108-15. doi: 10.1002/cncr.23923.
BACKGROUND
The study aimed to identify factors associated with less-than-optimal radiotherapy (RT) and its impact on disease-free survival in women aged 66+ years diagnosed with stage I breast cancer or ductal carcinoma in situ (DCIS).
METHODS
The subjects were women diagnosed from 1991 to 1999 in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database who underwent breast-conserving surgery and RT within 12 months postdiagnosis. The authors conducted descriptive and multivariate survival analyses, and considered age, race, poverty, marital status, comorbidity indices, rural/urban, radiation oncologist density, comedo necrosis histology (DCIS only), chemotherapy receipt (stage I only), and RT completion (3+ weeks of treatment) and delay (8+ weeks postsurgery without chemotherapy; 4+ weeks postchemotherapy).
RESULTS
Of 7791 subjects, 16% experienced RT delay, and 3% had incomplete RT. Subjects with stage I disease who were more likely to delay RT were of black race (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.17-2.08), whereas women in areas of high radiation oncologist density were less likely to delay (OR, 0.73; 95% CI, 0.66-0.81). Those living in high poverty areas were less likely to complete RT (P < .03), as were those undergoing chemotherapy (OR, 1.82; 95% CI, 1.15-2.88). Stage I breast cancer patients with delayed RT were more likely to experience a subsequent breast event (OR, 1.14; 95% CI, 1.00-1.30), and those with incomplete RT had a higher rate of overall mortality (OR, 1.32; 95% CI, 1.06-1.63). Factors associated with lower subsequent breast events included older age, lower poverty, and being married. RT delays of 12+ weeks (or 8+ weeks postchemotherapy) had a strongly negative impact on subsequent events (OR, 3.94; 95% CI, 2.51-6.17 for DCIS; OR, 2.77; 95% CI, 1.84-2.59 for stage I).
CONCLUSIONS
RT should be facilitated to ensure completion and timeliness, especially for early invasive breast cancer patients.
背景
本研究旨在确定与66岁及以上诊断为I期乳腺癌或原位导管癌（DCIS）的女性接受不理想放疗（RT）相关的因素及其对无病生存期的影响。
方法
研究对象为1991年至1999年在关联的监测、流行病学和最终结果（SEER）-医疗保险数据库中确诊的女性，她们在确诊后12个月内接受了保乳手术和放疗。作者进行了描述性和多变量生存分析，并考虑了年龄、种族、贫困程度、婚姻状况、合并症指数、农村/城市、放射肿瘤学家密度、粉刺样坏死组织学（仅DCIS）、化疗接受情况（仅I期）以及放疗完成情况（治疗3周以上）和延迟情况（术后8周以上未化疗；化疗后4周以上）。
结果
在7791名研究对象中，16%经历了放疗延迟，3%放疗未完成。I期疾病患者中更有可能延迟放疗的是黑人（优势比[OR]，1.56；95%置信区间[CI]，1.17 - 2.08），而在放射肿瘤学家密度高的地区的女性延迟放疗的可能性较小（OR，0.73；95%CI，0.66 - 0.81）。生活在高贫困地区的人完成放疗的可能性较小（P <.03），接受化疗的人也是如此（OR，1.82；95%CI，1.15 - 2.88）。I期乳腺癌放疗延迟的患者更有可能经历后续乳腺事件（OR，1.14；95%CI，1.00 - 1.30），而放疗未完成的患者总体死亡率更高（OR，1.32；95%CI，1.06 - 1.63）。与较低后续乳腺事件相关的因素包括年龄较大、贫困程度较低和已婚。放疗延迟12周以上（或化疗后8周以上）对后续事件有强烈负面影响（对于DCIS，OR，3.94；95%CI，2.51 - 6.17；对于I期，OR，2.77；95%CI，1.84 - 2.59）。
结论
应促进放疗以确保完成和及时性，特别是对于早期浸润性乳腺癌患者。
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