Department of Surgery, Division of Surgical Oncology, University of California at Davis, Sacramento, CA, USA.
Med Oncol. 2012 Sep;29(3):1523-8. doi: 10.1007/s12032-011-0077-8. Epub 2011 Oct 8.
Post-mastectomy radiation therapy (PMRT) is indicated for local-regionally advanced breast cancer (LABC). We hypothesized that candidates for PMRT from non-urban areas would receive lower rates of RT than urban patients and would have poorer overall survival (OS) and disease-specific survival (DSS). We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with LABC and treated with mastectomy in Sacramento and its surrounding 13 counties between 2000 and 2006. All patients were eligible to receive RT according to established guidelines, with tumors >5 cm size, ≥ 4 metastatic lymph nodes, or both. According to a United States Department of Agriculture scale, we designated counties as urban or non-urban and used multivariate logistic regression and Cox proportional hazards models to predict the use of RT, overall survival (OS), and disease-specific survival (DSS). Density of radiation oncologists in non-urban and urban counties was determined using the American Medical Association database in relation to census-derived populations of the respective counties. Entry criteria were met by 1,507 patients. Most (56.5%) were from urban counties; only 61% received RT. There was no radiation oncologist listed for 8/10 non-urban counties and 2/4 urban counties. Each radiation oncologist served 88,804 people in non-urban counties and 68,624 residents in urban counties. On multivariate analysis, non-urban patients (OR 0.56, CI 0.44-0.72) and increasing age were the only factors predicting a decreased likelihood of receiving RT (OR 0.97, CI 0.96-0.98). Patients not receiving PMRT experienced poorer OS (HR 1.77, CI 1.39-2.25; P < 0.001) and DSS (HR 1.62, CI 1.23-2.15; P = 0.001); however, non-urban status did not predict OS or DSS. Non-urban residents with LABC are less likely to receive indicated PMRT. This discrepancy may be due to limited RT access in non-urban areas. The lack of poorer OS and DSS due to this disparity requires further study.
术后放疗（PMRT）适用于局部区域性晚期乳腺癌（LABC）。我们假设非城市地区的 PMRT 候选者接受放疗的比例低于城市患者，并且总体生存率（OS）和疾病特异性生存率（DSS）较差。我们使用监测、流行病学和最终结果数据库，确定了 2000 年至 2006 年间在萨克拉门托及其周边 13 个县接受乳腺癌根治术治疗的 LABC 患者。所有患者均符合既定指南的放疗标准，肿瘤> 5cm 大小，≥ 4 个转移性淋巴结，或两者兼有。根据美国农业部的规模，我们将县划分为城市或非城市，并使用多变量逻辑回归和 Cox 比例风险模型来预测放疗的使用、总体生存率（OS）和疾病特异性生存率（DSS）。非城市和城市县的放射肿瘤学家密度是根据美国医学协会数据库相对于各自县的人口普查得出的人口来确定的。1507 名患者符合入组标准。大多数（56.5%）来自城市县；只有 61%的患者接受了放疗。10 个非城市县中有 8 个和 4 个城市县中有 2 个没有列出放射肿瘤学家。非城市县每位放射肿瘤学家服务 88804 人，城市县每位服务 68624 人。多变量分析表明，非城市患者（OR 0.56，CI 0.44-0.72）和年龄增加是预测放疗可能性降低的唯一因素（OR 0.97，CI 0.96-0.98）。未接受 PMRT 的患者的 OS（HR 1.77，CI 1.39-2.25；P < 0.001）和 DSS（HR 1.62，CI 1.23-2.15；P = 0.001）较差；然而，非城市状态并未预测 OS 或 DSS。患有 LABC 的非城市居民不太可能接受规定的 PMRT。这种差异可能是由于非城市地区放疗机会有限。由于这种差异导致的 OS 和 DSS 较差的情况需要进一步研究。
Zotero 插件