Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Pract Radiat Oncol. 2013 Jul-Sep;3(3):209-215. doi: 10.1016/j.prro.2012.05.006. Epub 2012 Jun 27.
To evaluate compliance with postmastectomy radiation therapy (PMRT) guidelines in breast cancer patients in China over a 10-year period.
A hospital-based, nationwide, multicenter retrospective epidemiologic study of primary breast cancer in women was conducted. Seven first-class, upper-level hospitals from different geographic regions of China were selected. One month was randomly selected to represent each year from 1999-2008 in every hospital. All inpatient cases within the selected months were reviewed and demographic, clinical, and pathologic characteristics and treatment patterns were collected. Patients enrolled in this study had to meet the following inclusion criteria: (1) treated with mastectomy and axillary dissection; (2) information regarding whether or not they received postmastectomy radiation therapy was available; and (3) information about staging was available. Patients were divided into 3 groups based on National Comprehensive Cancer Network guidelines. Utilization of PMRT in each group was analyzed and compared between different years and different hospitals.
A total of 2310 patients were analyzed. There were 643 (27.8%) patients in the PMRT recommended group, 557 (24.1%) patients in the controversial group, and 1110 (48.1%) patients in the nonrecommended group. PMRT was used in 48.8% of patients in the recommended group, 15.6% in the controversial group, and 5.7% in the nonrecommended group. There was a trend toward increasing use of radiation therapy in the recommended and controversial groups from 1999-2008. The use of PMRT in the nonrecommended group remained relatively stable from 1999-2008. Fewer positive nodes and nonreceipt of chemotherapy or hormone therapy were associated with underuse of PMRT in the recommended group. In the controversial group, a higher ratio of positive nodes was associated with use of PMRT.
There is an apparent underuse of PMRT in the PMRT recommended group. Efforts should be made to improve the compliance to PMRT guidelines.
在过去 10 年中，评估中国乳腺癌患者接受乳腺癌根治术后放疗 (PMRT) 指南的情况。
这是一项基于医院的、全国性的、多中心的女性原发性乳腺癌回顾性流行病学研究。从中国不同地理区域的 7 家一流、高水平医院中选择了 1 家。每家医院随机选择 1999-2008 年中的 1 个月作为代表，回顾所有选定月份的住院病例，收集人口统计学、临床和病理学特征以及治疗模式。参加本研究的患者必须符合以下纳入标准：(1)接受乳腺癌根治术和腋窝清扫术；(2)有或无接受乳腺癌根治术后放疗的信息；(3)有分期信息。患者被分为 3 组，依据美国国家综合癌症网络指南。分析每组患者接受 PMRT 的情况，并比较不同年份和不同医院之间的差异。
共分析了 2310 例患者。在 PMRT 推荐组中有 643 例(27.8%)患者，在有争议组中有 557 例(24.1%)患者，在不推荐组中有 1110 例(48.1%)患者。PMRT 推荐组、有争议组和不推荐组中，分别有 48.8%、15.6%和 5.7%的患者接受了放疗。从 1999-2008 年，推荐组和有争议组中放疗使用率呈上升趋势。而不推荐组从 1999-2008 年中 PMRT 的使用率相对稳定。推荐组中，淋巴结阳性数量较少、未接受化疗或激素治疗与 PMRT 使用率低有关。在有争议组中，更多的淋巴结阳性与 PMRT 的应用有关。
PMRT 推荐组中明显存在 PMRT 应用不足的情况。应努力提高 PMRT 指南的依从性。
