Minicozzi Pamela, Cirilli Claudia, Federico Massimo, Capocaccia Riccardo, Budroni Mario, Candela Pina, Falcini Fabio, Fusco Mario, Giacomin Adriano, La Rosa Francesco, Traina Adele, Tumino Rosario, Sant Milena
1Department of Preventive and Predictive Medicine, Analytical Epidemiology Unit, FondazioneIRCSS Istituto Nazionale dei Tumori, Milan, Italy.
Tumori. 2012 Mar-Apr;98(2):204-9. doi: 10.1177/030089161209800204.
Population-based cancer registry studies of patterns of care can help elucidate reasons for differences in breast cancer survival across Italy documented by previous studies. The aims of the present study were to investigate across-country variation in stage at presentation and standard care for breast cancer cases diagnosed in Italy in the early 2000s.
Samples of adult (≥ 15 years) women with breast cancer diagnosed in 2003-2005 were randomly selected in 9 Italian cancer registries. Logistic regression models were used to estimate the odds of receiving breast-conserving surgery plus radiotherapy (BCS + RT) in each cancer registry, age group, and disease stage category compared with the entire sample (reference); the z test was used to evaluate differences in proportions of stage at diagnosis, employment of chemotherapy in node-positive (N+) disease, and use of endocrine treatment in estrogen-receptor positive (ER+) and negative (ER-) tumors across Italy.
Stage at diagnosis was earlier in northern/central registries than in southern areas. Compared with the reference, the odds of receiving BCS + RT was significantly lower in Trapani, Sassari and Naples (southern Italy) after adjusting for age and stage at diagnosis. Among N+ patients, 73% received adjuvant chemotherapy (range, 51% [Biella, northern Italy] to 87% [Ragusa, southern Italy]). Eighty percent of ER+ cancers (range, 50% [Biella, northern Italy] to 97% [Ragusa, southern Italy]) and 18% of ER- cancers (range, 6% [Modena, northern Italy] to 28% [Umbria, central Italy]) were treated with hormonal therapy.
Disparities in stage distributions and conservative surgery in breast cancer persist across Italy. On a positive note, we found lower variations in the use of systemic treatment between Italian regions.
基于人群的癌症登记研究中关于治疗模式的研究有助于阐明先前研究所记录的意大利各地乳腺癌生存率差异的原因。本研究的目的是调查21世纪初在意大利诊断出的乳腺癌病例在就诊时的分期和标准治疗方面的国家间差异。
在9个意大利癌症登记处随机抽取了2003年至2005年诊断为乳腺癌的成年（≥15岁）女性样本。使用逻辑回归模型估计每个癌症登记处、年龄组和疾病分期类别中接受保乳手术加放疗（BCS + RT）与整个样本（参考）相比的几率；z检验用于评估意大利各地诊断时的分期比例、淋巴结阳性（N +）疾病中化疗的使用以及雌激素受体阳性（ER +）和阴性（ER -）肿瘤中内分泌治疗的使用差异。
北部/中部登记处的诊断分期比南部地区更早。在调整年龄和诊断分期后，特拉帕尼、萨萨里和那不勒斯（意大利南部）接受BCS + RT的几率显著低于参考值。在N +患者中，73%接受了辅助化疗（范围为51%[意大利北部的比耶拉]至87%[意大利南部的拉古萨]）。80%的ER +癌症（范围为50%[意大利北部的比耶拉]至97%[意大利南部的拉古萨]）和18%的ER -癌症（范围为6%[意大利北部的摩德纳]至28%[意大利中部的翁布里亚]）接受了激素治疗。
意大利各地乳腺癌的分期分布和保乳手术存在差异。积极的一面是，我们发现意大利各地区在全身治疗的使用上差异较小。
