Chu Quyen D, Caldito Gloria, Miller J Karen, Townsend Beth
Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA; Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA.
Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA.
J Am Coll Surg. 2015 Apr;220(4):659-69. doi: 10.1016/j.jamcollsurg.2014.12.045. Epub 2015 Jan 14.
The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines recommend postmastectomy radiation therapy (PMRT) for women with N2/N3 breast cancer. We examined the compliance rate of PMRT using the National Cancer Data Base and determined what factors are associated with low compliance rate with PMRT.
The National Cancer Data Base, comprising 2,720,368 breast cancer cases diagnosed between 1998 and 2011, was evaluated. From this database, 56,990 women with N2/N3 diseases were evaluated. Statistics used include chi-square test, 2-sample t-test or Wilcoxon rank-sum test, and multivariate analysis.
Mean age of the patients was 58 years and median follow-up was 61 months. The majority of patients were from a comprehensive community cancer programs (59%), were Caucasian (81%), had health insurance (96%), resided in urban communities (98%), and had no comorbidities (83%). Approximately 82% received chemotherapy, but only 65% had PMRT. Factors associated with PMRT are tumor grade (p = 0.03), regional lymph node surgery (p = 0.03), readmission within 30 days of surgical discharge (p = 0.03), receipt of chemotherapy (p < 0.01) and hormonal therapy (p < 0.01), and 30-day mortality (p < 0.01). Socioeconomic variables, such as facility type (p = 0.85), facility geographic location (p = 0.27), race/ethnicity (p = 0.12), insurance status (p = 0.10), income level (p = 0.43), education level (p = 0.86), residential location (p = 0.83), and comorbidities (p = 0.83) were not contributory factors. Independent variables predicting compliance with PMRT include receipt of chemotherapy (odds ratio = 4.55; p < 0.01), readmission within 30 days after surgery (odds ratio = 1.14; p = 0.01), and alive within 30 days after surgery (odds ratio = 1.55; p = 0.04).
One third of patients with N2/N3 disease did not receive PMRT. Socioeconomic variables were not contributory factors. Noncompliance with PMRT is related to lack of receipt of chemotherapy, nonreadmission, or death within 30 days after surgery.
美国国立综合癌症网络和美国临床肿瘤学会指南推荐对N2/N3期乳腺癌女性进行乳房切除术后放射治疗（PMRT）。我们利用国家癌症数据库检查了PMRT的依从率，并确定了哪些因素与PMRT的低依从率相关。
对国家癌症数据库进行了评估，该数据库包含1998年至2011年期间诊断的2,720,368例乳腺癌病例。从该数据库中，对56,990例患有N2/N3疾病的女性进行了评估。使用的统计方法包括卡方检验、双样本t检验或Wilcoxon秩和检验以及多变量分析。
患者的平均年龄为58岁，中位随访时间为61个月。大多数患者来自综合社区癌症项目（59%），为白种人（81%），有健康保险（96%），居住在城市社区（98%），且无合并症（83%）。约82%的患者接受了化疗，但只有65%的患者进行了PMRT。与PMRT相关的因素包括肿瘤分级（p = 0.03）、区域淋巴结手术（p = 0.03）、手术出院后30天内再次入院（p = 0.03）、接受化疗（p < 0.01）和激素治疗（p < 0.01）以及30天死亡率（p < 0.01）。社会经济变量，如机构类型（p = 0.85）、机构地理位置（p = 0.27）、种族/民族（p = 0.12）、保险状况（p = 0.10）、收入水平（p = 0.43）、教育水平（p = 0.86）居住地点（p = 0.83）和合并症（p = 0.83）不是促成因素。预测PMRT依从性的独立变量包括接受化疗（优势比 = 4.55；p < 0.01）、手术后30天内再次入院（优势比 = 1.14；p = 0.01）以及手术后30天内存活（优势比 = 1.55；p = 0.04）。
三分之一的N2/N3期疾病患者未接受PMRT。社会经济变量不是促成因素。未进行PMRT与未接受化疗、未再次入院或手术后30天内死亡有关。
