Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece.
Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Clin Breast Cancer. 2018 Aug;18(4):e469-e476. doi: 10.1016/j.clbc.2017.07.010. Epub 2017 Jul 18.
It has been reported that some patients with breast cancer may refuse cancer-directed surgery, but the incidence in the United States is not currently known. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with refusal of recommended breast cancer-directed surgery.
A retrospective review of the Surveillance Epidemiology and End Results (SEER) database between 2004 and 2013 was performed. Patients who underwent cancer-directed surgery were compared with patients in whom cancer-directed surgery was refused, even though it was recommended.
Of 531,700 patients identified, 3389 (0.64%) refused surgery. An increasing trend was observed from 2004 to 2013 (P = .009). Older age (50-69: odds ratio [OR] 4.96; 95% confidence interval, 1.23-19.96; P = .024, ≥ 70 years: OR 17.27; 95% CI, 4.29-69.54; P < .001), ethnicity (P < .001), marital status (single: OR 2.28; 95% CI, 1.98-2.62; P < .001, separated/divorced/widowed: OR 2.26; 95% CI, 2.01-2.53; P < .001), higher stage (II: OR 2.05; 95% CI, 1.83-2.3; P < .001, III: OR 2.2; 95% CI, 1.87-2.6; P < .001, IV: OR 13.3; 95% CI, 11.67-15.16; P < .001), and lack of medical insurance (OR 2.11; 95% CI, 1.59-2.8; P < .001) were identified as risk factors associated with refusal of surgery. Survival analysis showed a 2.42 higher risk of mortality in these patients.
There has been an increasing rate of patients refusing recommended surgery, which significantly affects survival. Age, ethnicity, marital status, disease stage, and lack of insurance are associated with higher risk of refusal of surgery.
据报道，一些乳腺癌患者可能会拒绝接受癌症定向手术，但目前尚不清楚美国的发病率。本研究的目的是确定与拒绝推荐的乳腺癌定向手术相关的发生率、趋势、风险因素和最终生存结果。
对 2004 年至 2013 年期间监测流行病学和最终结果（SEER）数据库进行了回顾性分析。比较了接受癌症定向手术的患者与拒绝接受癌症定向手术的患者，即使该手术被推荐。
在确定的 531700 名患者中，有 3389 名（0.64%）拒绝了手术。从 2004 年到 2013 年，观察到一种上升趋势（P=0.009）。年龄较大（50-69 岁：优势比[OR]4.96；95%置信区间，1.23-19.96；P=0.024，≥70 岁：OR 17.27；95%置信区间，4.29-69.54；P<0.001）、种族（P<0.001）、婚姻状况（单身：OR 2.28；95%置信区间，1.98-2.62；P<0.001，分居/离婚/丧偶：OR 2.26；95%置信区间，2.01-2.53；P<0.001）、较高的疾病分期（II 期：OR 2.05；95%置信区间，1.83-2.3；P<0.001，III 期：OR 2.2；95%置信区间，1.87-2.6；P<0.001，IV 期：OR 13.3；95%置信区间，11.67-15.16；P<0.001）和缺乏医疗保险（OR 2.11；95%置信区间，1.59-2.8；P<0.001）被确定为与手术拒绝相关的风险因素。生存分析显示，这些患者的死亡率风险增加了 2.42 倍。
拒绝接受推荐手术的患者比例呈上升趋势，这显著影响了生存。年龄、种族、婚姻状况、疾病分期和缺乏保险与手术拒绝的风险增加相关。
