乳腺癌患者的生存情况：基于澳大利亚数据，按外科医生病例量、治疗中心位置和健康保险状况进行的分析。

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status.

作者信息

Roder David, de Silva Primali, Zorbas Helen M, Kollias James, Malycha Peter L, Pyke Chris M, Campbell Ian D

机构信息

Population Health, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.

出版信息

Aust Health Rev. 2012 Aug;36(3):342-8. doi: 10.1071/AH11060.

DOI:10.1071/AH11060

PMID:22935129

Abstract

OBJECTIVE

Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status.

METHOD

Deaths were traced to 31 December 2007, for cancers diagnosed in 1998-2005. Risk of breast cancer death was compared using Cox proportional hazards regression.

RESULTS

When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower when surgeons' annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21-100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P ≥ 0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status.

CONCLUSION

Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.

摘要

目的

利用澳大利亚国家乳腺癌审计的早期浸润性乳腺癌数据，比较不同外科医生病例量、治疗中心位置和健康保险状况下的病例死亡率。

方法

对1998 - 2005年诊断的癌症患者追踪至2007年12月31日的死亡情况。使用Cox比例风险回归比较乳腺癌死亡风险。

结果

在对年龄和临床风险因素进行调整后：（i）当外科医生的年病例量超过20例时，乳腺癌死亡的相对风险（95%置信区间）较低，21 - 100例时为0.87（0.76，0.995），更高病例量时为0.83（0.72，0.97）。在同时调整治疗中心位置后，这些相对风险无统计学意义（P≥0.15）；（ii）与主要城市中心相比，内陆地区中心的相对风险为1.32（1.18，1.48），但更偏远地区的风险未升高，为0.95（0.74，1.22）。死亡风险与私人保险状况无关。