Gold Heather Taffet, Do Huong T, Dick Andrew W
Weill Cornell Medical College, New York, New York 10021, USA.
Cancer. 2008 Dec 1;113(11):3108-15. doi: 10.1002/cncr.23923.
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).
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).
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).
RT should be facilitated to ensure completion and timeliness, especially for early invasive breast cancer patients.
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。
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）。
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）。
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。
