The University of Michigan, Ann Arbor, MI, USA.
Curr Med Res Opin. 2012 Mar;28(3):419-28. doi: 10.1185/03007995.2011.628649. Epub 2012 Feb 24.
Triple-negative breast cancer (TNBC) makes up 10-17% of all breast cancers and, due to lack of receptor expression, is unresponsive to therapies that target hormonal receptors or HER2. Unique in its tumor aggression and high rates of recurrence, TNBC is less likely to be detected by mammogram and has a poorer prognosis than other breast cancer subtypes (non-TNBC).
To examine the survival, healthcare utilization, and healthcare cost for women with TNBC compared with non-TNBC breast cancer.
The study population was derived from a US managed care cancer registry linked to health insurance claims and social security mortality data. Based on initial type and stage at diagnosis, patients were divided into two cohorts: patients with TNBC and those with non-TNBC. Records were analyzed from initial diagnosis until death, disenrollment, or end of observation period. Survival and annual healthcare utilization and costs were estimated and compared between cohorts after adjusting for baseline demographic characteristics, comorbidities, and prior resource use. Subgroup analyses were performed in patients diagnosed with stage I-III and IV breast cancer.
The study included women diagnosed with TNBC (n = 450) and non-TNBC (n = 1807). Median follow-up time for all patients was 716 days (688.5 and 733 days for TNBC and non-TNBC patients, respectively). After initial diagnosis, overall mortality risk for the TNBC cohort was twice as high as the non-TNBC cohort (HR = 2.02, p < 0.0001). Patients with TNBC had more annual hospitalizations, hospitalized days, and number of emergency room visits relative to non-TNBC. Despite similar annual total healthcare costs, adjusted inpatient costs for patients with non-TNBC averaged 77% higher ($8395 vs. $4745, p < 0.0001). Furthermore, payer reimbursements were higher for TNBC than non-TNBC patients ($8213 vs. $4486, p < 0.0001).
While it does not control for race or socioeconomic status, this study found that in a US managed care setting, patients with TNBC compared with non-TNBC have significantly shorter survival, accompanied by higher inpatient utilization and healthcare costs.
三阴性乳腺癌（TNBC）占所有乳腺癌的 10-17%，由于缺乏受体表达，对针对激素受体或 HER2 的治疗无反应。TNBC 在肿瘤侵袭性和复发率方面独一无二，其不太可能通过乳房 X 光检查检测到，并且预后比其他乳腺癌亚型（非 TNBC）差。
检查 TNBC 与非 TNBC 乳腺癌女性的生存、医疗保健利用和医疗保健成本。
研究人群来自美国管理式医疗癌症登记处，与健康保险索赔和社会保障死亡率数据相关联。根据初始诊断时的类型和阶段，患者分为两个队列：TNBC 患者和非 TNBC 患者。记录从初始诊断开始，直至死亡、退出或观察期结束。在调整基线人口统计学特征、合并症和先前资源使用情况后，对两个队列的生存和年度医疗保健利用和成本进行估计和比较。在诊断为 I-III 期和 IV 期乳腺癌的患者中进行了亚组分析。
该研究纳入了诊断为 TNBC（n=450）和非 TNBC（n=1807）的女性。所有患者的中位随访时间为 716 天（TNBC 和非 TNBC 患者分别为 688.5 和 733 天）。初始诊断后，TNBC 队列的总死亡率是非 TNBC 队列的两倍（HR=2.02，p<0.0001）。与非 TNBC 相比，TNBC 患者的年住院次数、住院天数和急诊就诊次数更多。尽管年度总医疗保健费用相似，但非 TNBC 患者的住院费用调整后平均高出 77%（$8395 比 $4745，p<0.0001）。此外，TNBC 患者的报销金额高于非 TNBC 患者（$8213 比 $4486，p<0.0001）。
虽然本研究未控制种族或社会经济地位，但发现在美国管理式医疗环境中，与非 TNBC 相比，TNBC 患者的生存时间明显更短，同时住院利用率和医疗保健成本更高。
