Sinha Arup K, Patel Jenil R, Shen Yu, Ueno Naoto T, Giordano Sharon H, Tripathy Debu, Lopez David S, Barcenas Carlos H
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Department of Biostatistics, The University of Texas School of Public Health, Houston, Texas, United States of America.
PLoS One. 2017 Jan 13;12(1):e0170081. doi: 10.1371/journal.pone.0170081. eCollection 2017.
Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment.
We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).
We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9-6.0; RFS: HR = 5.8, 95% CI = 4.8-7.0; DRFS: HR = 5.4, 95% CI = 4.5-6.6).
Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.
癌症治疗结果因治疗地点而异。我们通过长期乳腺癌幸存者最初治疗的地点，评估了一家专科医院中这些幸存者的治疗结果差异。
我们回顾性研究了一组被诊断为侵袭性早期乳腺癌的女性队列，这些女性在诊断日期后至少5年未复发，并于1997年1月至2008年8月在德克萨斯大学MD安德森癌症中心接受评估。最初治疗的地点分为MD安德森癌症中心（MD安德森治疗组）或其他（其他治疗组）。分析的结果包括无复发生存期（RFS）、无远处复发生存期（DRFS）和总生存期（OS）。采用Kaplan-Meier乘积限法比较两组的治疗结果。使用Cox比例风险模型估计风险比（HR）和95%置信区间（CI）。
我们确定了5091名乳腺癌幸存者（中位随访8.6年），其中89.1%在MD安德森癌症中心接受治疗。MD安德森治疗组的10年总生存期、无复发生存期和无远处复发生存期率分别为90.9%、88.4%和89.0%，其他治疗组分别为74.3%、49.8%和52.7%。在单变量分析和多变量分析中，我们均观察到其他治疗组的治疗结果较差（总生存期：HR = 4.8，95% CI = 3.9 - 6.0；无复发生存期：HR = 5.8，95% CI = 4.8 - 7.0；无远处复发生存期：HR = 5.4，95% CI = 4.5 - 6.6）。
在MD安德森癌症中心开始治疗的长期乳腺癌幸存者有更好的治疗结果。最初治疗的地点可能是专科医院生存结果的一个独立风险因素。本分析存在回顾性观察研究固有的局限性，例如其他未测量的变量可能与更差的预后相关。
