老年女性导管原位癌和 I 期乳腺癌患者的诊断前抑郁症状和健康相关生活质量对治疗选择的影响。

Impact of pre-diagnosis depressive symptoms and health-related quality of life on treatment choice for ductal carcinoma in situ and stage I breast cancer in older women.

机构信息

Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.

Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.

出版信息

Breast Cancer Res Treat. 2019 Feb;173(3):709-717. doi: 10.1007/s10549-018-5006-5. Epub 2018 Nov 8.

DOI:10.1007/s10549-018-5006-5

PMID:30406869

Abstract

PURPOSE

To examine whether pre-diagnosis patient-reported health-related quality of life (HRQOL) and depressive symptoms are associated with local treatment for older women with ductal carcinoma in situ (DCIS) and stage I breast cancer (BC).

METHODS

Using the SEER-MHOS dataset, we identified women ≥ 65 years old with DCIS or stage I BC diagnosed 1998-2011 who completed surveys ≤ 24 months before diagnosis. Depressive symptoms were measured by major depressive disorder (MDD) risk and HRQOL was measured by Physical and Mental Component Summary scores (PCS and MCS, respectively) of the SF-36/VR-12. Associations with treatment choice (breast-conserving surgery [BCS] and radiation therapy [RT], BCS alone, mastectomy) were assessed with multivariable multinomial logistic regression, controlling for patient characteristics.

RESULTS

We identified 425 women with DCIS and 982 with stage I BC. Overall, 20.4% endorsed depressive symptoms placing them at risk for MDD pre-diagnosis; mean MCS and PCS scores were 52.3 (SD = 10.1) and 40.5 (SD = 11.5), respectively. Among women with DCIS, those at risk for MDD were more likely to receive BCS (adjusted odds ratio [AOR] 2.04, 95% CI 1.04-4.00, p = 0.04) or mastectomy (AOR 1.88, 95% CI 0.91-3.86, p = 0.09) compared to BCS + RT. For DCIS, MCS score was not associated with treatment; higher PCS score was associated with decreased likelihood of receiving mastectomy versus BCS + RT (AOR 0.71 per 10-point increase, 95% CI 0.54-0.95, p = 0.02). For BC, none of the measures were significantly associated with treatment.

CONCLUSION

Older women at risk for MDD before DCIS diagnosis were less likely to receive RT after BCS, compared to BCS alone or mastectomy.

摘要

目的

探讨老年女性导管原位癌（DCIS）和 I 期乳腺癌（BC）患者诊断前的患者报告健康相关生活质量（HRQOL）和抑郁症状与局部治疗的关系。

方法

利用 SEER-MHOS 数据集，我们纳入了 1998-2011 年诊断为 DCIS 或 I 期 BC、且诊断前≤24 个月完成调查的≥65 岁女性。抑郁症状通过重大抑郁障碍（MDD）风险评估，HRQOL 通过 SF-36/VR-12 的生理和心理成分综合评分（PCS 和 MCS）来衡量。采用多变量多项逻辑回归评估治疗选择（保乳手术[BCS]和放疗[RT]、BCS 单独、乳房切除术）与治疗选择的相关性，同时控制患者特征。

结果

我们纳入了 425 例 DCIS 患者和 982 例 I 期 BC 患者。总体而言，20.4%的患者有抑郁症状，存在 MDD 风险；平均 MCS 和 PCS 评分为 52.3（SD=10.1）和 40.5（SD=11.5）。在 DCIS 患者中，有 MDD 风险的患者更有可能接受 BCS（调整后比值比[OR] 2.04，95%CI 1.04-4.00，p=0.04）或乳房切除术（OR 1.88，95%CI 0.91-3.86，p=0.09），而不是 BCS+RT。对于 DCIS，MCS 评分与治疗无关；较高的 PCS 评分与接受乳房切除术而非 BCS+RT 的可能性降低相关（每增加 10 分的 OR 为 0.71，95%CI 0.54-0.95，p=0.02）。对于 BC，没有任何指标与治疗显著相关。