Yale School of Medicine, Yale University, New Haven, Connecticut.
Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, Yale University, New Haven, Connecticut.
Cancer. 2017 Feb 1;123(3):502-511. doi: 10.1002/cncr.30356. Epub 2016 Sep 22.
The current study was performed to determine whether access to facilities performing accelerated partial breast irradiation (APBI) is associated with differences in the use of adjuvant radiotherapy (RT).
Using the National Cancer Data Base, the authors performed a retrospective study of women aged ≥50 years who were diagnosed with early-stage breast cancer between 2004 and 2013 and treated with breast-conserving surgery (BCS). Facilities performing APBI in ≥10% of their eligible patients within a given year were defined as APBI facilities whereas those not performing APBI were defined as non-APBI facilities. All other facilities were excluded. The authors identified independent factors associated with RT use using multivariable logistic regression with clustering in the overall sample as well as in subsets of patients with standard-risk invasive cancer, low-risk invasive cancer, and ductal carcinoma in situ.
Among 222,544 patients, 76.6% underwent BCS plus RT and 23.4% underwent BCS alone. The likelihood of RT receipt in the overall sample did not appear to differ significantly between APBI and non-APBI facilities (adjusted odds ratio [AOR], 1.02; P = .61). Subgroup multivariable analysis demonstrated that among patients with standard-risk invasive cancer, there was no association between evaluation at an APBI facility and receipt of RT (AOR, 0.98; P = .69). However, patients with low-risk invasive cancer were found to be significantly more likely to receive RT (54.4% vs 59.5%; AOR, 1.22 [P<.001]), whereas patients with ductal carcinoma in situ were less likely to receive RT (56.9% vs 55.3%; AOR, 0.89 [P = .04]) at APBI facilities.
Patients who were eligible for observation were more likely to receive RT in APBI facilities but no difference was observed among patients with standard-risk invasive cancer who would most benefit from RT. Cancer 2017;123:502-511. © 2016 American Cancer Society.
本研究旨在探讨能否通过设施是否能够提供加速部分乳房照射（APBI）来确定辅助放疗（RT）的应用是否存在差异。
作者使用国家癌症数据库，对 2004 年至 2013 年间接受保乳手术（BCS）治疗的年龄≥50 岁的早期乳腺癌女性患者进行了回顾性研究。在给定的一年中，为≥10%符合条件的患者提供 APBI 的设施被定义为 APBI 设施，而未提供 APBI 的设施被定义为非 APBI 设施。排除所有其他设施。作者使用多变量逻辑回归分析了与 RT 使用相关的独立因素，并在总体样本以及标准风险浸润性癌、低危浸润性癌和导管原位癌亚组中进行了聚类分析。
在 222544 例患者中，76.6%接受了 BCS 加 RT，23.4%仅接受了 BCS。在总体样本中，APBI 设施和非 APBI 设施之间 RT 接受率似乎没有显著差异（调整后比值比[OR]，1.02；P=0.61）。亚组多变量分析表明，在标准风险浸润性癌患者中，在 APBI 设施接受评估与接受 RT 之间没有关联（OR，0.98；P=0.69）。然而，低危浸润性癌患者接受 RT 的可能性显著更高（54.4%比 59.5%；OR，1.22[P<.001]），而导管原位癌患者接受 RT 的可能性更低（56.9%比 55.3%；OR，0.89[P=0.04]）。
有观察条件的患者更有可能在 APBI 设施中接受 RT，但在最受益于 RT 的标准风险浸润性癌症患者中没有观察到差异。癌症 2017；123:502-511。©2016 美国癌症协会。
