Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, United States.
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, New York, United States; Department of Veterans Affairs, NY, Harbor Healthcare System, Brooklyn, New York, United States.
J Geriatr Oncol. 2019 May;10(3):465-474. doi: 10.1016/j.jgo.2018.10.005. Epub 2018 Oct 22.
Disparities in the receipt of standard of care based on age have been identified for several types of cancer including cervical cancer. The purpose of this study is to analyze patterns of care and survival for older patients receiving definitive treatment in a large, national cohort.
The National Cancer Database was queried for patients with FIGO/AJCC IB2-IVA cervical cancer diagnosed from 2004 to 2014 who underwent definitive radiation or concurrent chemoradiation. Standard of care was defined as concurrent chemotherapy with external beam radiation and brachytherapy to a total dose ≥70 Gy. Multivariable logistic regression was used to determine factors associated with the receipt of standard of care. Multivariable Cox regression was used to determine covariables associated with differences in overall survival.
24,126 patients met inclusion criteria including 4052 women 61-70 years old, 2471 women 71-80 years old, and 1325 women over 80 years old. A smaller percentage of patients over age 60 received standard of care compared to younger aged patients. On multivariable analysis, older patients were less likely to be treated with standard of care. On multivariable Cox regression, ages 71-80 (HR 1.25, 95% CI-1.16-1.36, p < .001) and age > 80 (HR 1.90, 95% CI 1.73-2.07, P < .001) were associated with decreased overall survival. On subgroup analysis for patients with significant comorbidities, treatment with standard of care resulted in increased 5-year OS as compared to incomplete treatment.
Age was found to be an independent predictor for the receipt of standard of care treatment for cervical cancer.
基于年龄的护理标准差距已在多种癌症中得到确认，包括宫颈癌。本研究的目的是分析大量全国性队列中接受确定性治疗的老年患者的护理模式和生存情况。
从 2004 年至 2014 年，国家癌症数据库对国际妇产科联盟/美国癌症联合委员会（FIGO/AJCC）IB2-IVA 期宫颈癌诊断为宫颈癌的患者进行了查询，这些患者接受了确定性放射治疗或同期放化疗。标准护理被定义为接受外部束辐射和近距离放射治疗，总剂量≥70Gy 的同时进行化疗。多变量逻辑回归用于确定与接受标准护理相关的因素。多变量 Cox 回归用于确定与总生存差异相关的协变量。
24126 名患者符合纳入标准，其中 4052 名年龄在 61-70 岁的女性，2471 名年龄在 71-80 岁的女性，1325 名年龄在 80 岁以上的女性。年龄超过 60 岁的患者接受标准护理的比例低于年龄较小的患者。多变量分析显示，老年患者接受标准护理的可能性较小。多变量 Cox 回归分析显示，71-80 岁（HR 1.25，95%CI-1.16-1.36，p<0.001）和年龄>80 岁（HR 1.90，95%CI 1.73-2.07，p<0.001）与总生存时间缩短相关。对于患有显著合并症的患者亚组分析，与不完全治疗相比，标准治疗可提高 5 年 OS。
年龄是宫颈癌患者接受标准护理治疗的独立预测因素。
