Rhieu Byung-Han, Rajagopalan Malolan S, Sukumvanich Paniti, Kelley Joseph L, Ahrendt Gretchen M, Heron Dwight E, Beriwal Sushil
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Division of Gynecologic Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Pract Radiat Oncol. 2015 Jul-Aug;5(4):e267-73. doi: 10.1016/j.prro.2014.12.003. Epub 2015 Jan 22.
For well-selected elderly women who undergo segmental mastectomy for early-stage, estrogen receptor-positive breast cancer, hormonal therapy alone is emerging as an acceptable adjuvant therapy option since the initial publication of Cancer and Leukemia Group B 9343 study in 2004 and update in 2013. The rate of adoption of adjuvant hormonal therapy alone in lieu of radiation therapy (RT) and its associated patterns of care is not known in the United States and was the subject of this study.
We used the National Cancer Data Base to identify women aged ≥70 diagnosed with T1N0/T1Nx invasive breast cancer who underwent segmental mastectomy between 1998 and 2011. Because hormone receptor status was not specifically and reliably coded, only those who received hormonal therapy were included in this analysis. Univariate and multivariable exploratory analyses of factors associated with the use of RT were performed using SPSS, version 17.0.
Of the 182,115 patients who met inclusion criteria, 97,530 (53.6%) patients underwent hormonal therapy and were included in the analysis. The RT utilization rate in this subset decreased with time from 84.9% in 1998 to 75.1% in 2011 (P< .001). Multivariable analysis revealed that the factors associated with decreased use of RT include (in order of association): older age, later year of diagnosis, greater comorbidity score, low grade, lack of insurance, treatment at academic facility, race, rural location, lower median income, and distance from facility.
This study assesses the patterns of care associated with the omission of RT in elderly women with early-stage breast cancer who received adjuvant hormonal therapy. Since the publication of major clinical trials, this strategy has been increasingly adopted. The strongest predictors of using this strategy included advanced patient age, high comorbidity score, and low-grade disease.
自2004年癌症与白血病B组9343研究首次发表及2013年更新以来，对于精心挑选的、因早期雌激素受体阳性乳腺癌而接受乳房部分切除术的老年女性，单纯激素治疗正成为一种可接受的辅助治疗选择。在美国，单纯辅助激素治疗替代放射治疗（RT）的采用率及其相关的护理模式尚不清楚，本研究以此为主题。
我们利用国家癌症数据库，识别出1998年至2011年间年龄≥70岁、被诊断为T1N0/T1Nx浸润性乳腺癌且接受乳房部分切除术的女性。由于激素受体状态未被专门且可靠地编码，本分析仅纳入接受激素治疗的患者。使用SPSS 17.0版对与使用RT相关的因素进行单变量和多变量探索性分析。
在符合纳入标准的182,115例患者中，97,530例（53.6%）接受了激素治疗并纳入分析。该亚组中RT的使用率随时间从1998年的84.9%降至2011年的75.1%（P<0.001）。多变量分析显示，与RT使用减少相关的因素包括（按关联顺序）：年龄较大、诊断年份较晚、合并症评分较高、低分级、缺乏保险、在学术机构接受治疗、种族、农村地区、收入中位数较低以及距机构的距离。
本研究评估了接受辅助激素治疗的早期乳腺癌老年女性中与省略RT相关的护理模式。自主要临床试验发表以来，这一策略已被越来越多地采用。采用这一策略的最强预测因素包括患者年龄较大、合并症评分高和疾病分级低。
