印度南部的乳腺癌护理：实际操作是否符合国家指南？
Breast Cancer Care in South India: Is Practice Concordant With National Guidelines?
作者信息
Vijaykumar D K, Arun Sujana, Abraham Aswin G, Hopman Wilma, Robinson Andrew G, Booth Christopher M
机构信息
Amrita Institute of Medical Sciences and Research Centre, Cochin, India.
Kingston General Hospital Research Institute, Kingston, Ontario, Canada.
出版信息
J Glob Oncol. 2019 Jul;5:1-7. doi: 10.1200/JGO.19.00052.
PURPOSE
The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines.
METHODS
All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab.
RESULTS
A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab.
CONCLUSION
Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.
目的
印度国家癌症网格（NCG）最近发布了适用于印度情况的临床实践指南。我们评估了印度南部一家教学医院的乳腺癌护理与NCG指南的符合程度。
方法
纳入2014年1月至2015年12月在单一中心接受乳腺癌手术的所有患者。从电子病历中提取人口统计学、病理和治疗特征。患者被分类为符合从NCG指南中选取的六个要素。这些指标涉及前哨淋巴结（SLN）活检的合理使用、淋巴结清扫、辅助放疗、辅助化疗、人表皮生长因子受体2（HER2）检测以及辅助曲妥珠单抗的应用。
结果
共有401名女性接受了乳腺癌手术；平均年龄（标准差）为57（12）岁。队列中47%（401例中的188例）有淋巴结受累；23%（401例中的94例）患有T1期疾病。92%（401例中的368例）接受了根治性改良乳房切除术。75%（222例中的167例）符合条件的患者接受了SLN活检。前哨淋巴结活检阳性或未进行前哨淋巴结活检的患者中，80%（261例中的208例）清扫的淋巴结超过10个。67%（177例淋巴结阳性患者中的118例）接受了蒽环类和紫杉类辅助化疗。84%（213例保乳手术、T4期肿瘤或3个以上阳性淋巴结患者中的180例）接受了辅助放疗。免疫组化检测显示2+HER2阳性淋巴结的患者中，59%（73例中的43例）进行了荧光原位杂交检测。在HER2过表达的患者中，40%（91例中的36例）接受了辅助曲妥珠单抗治疗。
结论
乳腺癌护理与NCG指南的符合率在40%至84%之间。与患者直接成本最高的护理要素的指南符合率最低。
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