Bazan Jose G, Fisher James L, Park Ko Un, Marcus Elizabeth A, Bittoni Marisa A, White Julia R
Department of Radiation Oncology, Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.
Division of Clinical Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States.
Front Oncol. 2019 Jul 9;9:621. doi: 10.3389/fonc.2019.00621. eCollection 2019.
Lumpectomy (L) and breast radiotherapy (RT) results in equivalent outcomes in comparison to mastectomy (M) for early-stage breast cancer (BC) based on randomized controlled trials (RCT). Since 2004, RCT support that L without RT yields equivalent survival and acceptable local-regional outcomes in women ≥70-years old with T1N0 hormone-sensitive (ER+) BC on endocrine therapy. Based on this, we hypothesized that M rates should decrease substantially after 2004 in this low-risk elderly population. We used the Surveillance Epidemiology and End Results registry data to conduct this study. We included women with T1N0 ER+ BC from 2000 to 2014. We compared M rates in women diagnosed from 2000 to 2004 vs. 2005-2012 using the Chi-Square test. Logistic regression analyses was performed to examine demographic/clinical factors associated with mastectomy. 67,506 women met the study criteria. In elderly Stage I ER+ BC, the M rate decreased by 6.3%: 29.0% before 2004 to 22.7% after 2004 ( < 0.0001). M rates remained higher in elderly non-Hispanic black (NHB, 27.1%, < 0.0001), non-Hispanic Asian-Pacific-Islander (NHAPI, 30.1%, < 0.0001), and Hispanics (24.4%, = 0.0004) vs. non-Hispanic White (NHW, 21.5%). Treatment in the modern cohort was associated with decreased odds of mastectomy (OR = 0.71, 95% CI 0.68-0.74, < 0.0001) while NH-API race was associated with the highest increased odds of mastectomy (OR = 1.65, 95% 1.53-1.78, < 0.0001). In the modern cohort specifically (2005-2014), Hispanic women (OR = 1.12, = 0.014), NHB women (OR = 1.21, < 0.0001), and NHAPI women (OR = 1.73, < 0.0001) all had higher odds of undergoing mastectomy relative to NHW women after adjusting for all other patient and tumor related factors. In elderly patients with stage I, ER+ BC, M rates have decreased modestly since 2004. These trends are driven mostly be decreases in the M rate in NHW women, but M rates remain ~25% in Hispanic, NHB, and NHAPI women. Further research is needed to identify why M, which is associated with higher cost and morbidity than L alone, has not changed substantially in elderly, low-risk BC.
基于随机对照试验（RCT），对于早期乳腺癌（BC），与乳房切除术（M）相比，保乳手术（L）和乳房放疗（RT）可产生等效的结果。自2004年以来，RCT支持对于接受内分泌治疗的年龄≥70岁、T1N0激素敏感（ER +）乳腺癌女性，不进行放疗的保乳手术可产生等效的生存率和可接受的局部区域结果。基于此，我们假设在这个低风险老年人群中，2004年后乳房切除术的比例应大幅下降。我们使用监测、流行病学和最终结果登记数据进行了这项研究。我们纳入了2000年至2014年患有T1N0 ER +乳腺癌的女性。我们使用卡方检验比较了2000年至2004年与2005 - 2012年诊断的女性的乳房切除术比例。进行逻辑回归分析以检查与乳房切除术相关的人口统计学/临床因素。67,506名女性符合研究标准。在老年I期ER +乳腺癌中，乳房切除术比例下降了6.3%：2004年前为29.0%，2004年后为22.7%（P < 0.0001）。与非西班牙裔白人（NHW，21.5%）相比，老年非西班牙裔黑人（NHB，27.1%，P < 0.0001）、非西班牙裔亚太岛民（NHAPI，30.1%，P < 0.0001）和西班牙裔（24.4%，P = 0.0004）的乳房切除术比例仍然更高。现代队列中的治疗与乳房切除术几率降低相关（OR = 0.71，95%CI 0.68 - 0.74，P < 0.0001），而NH - API种族与乳房切除术几率增加最高相关（OR = 1.65，95% 1.53 - 1.78，P < 0.0001）。特别是在现代队列（2005 - 2014年）中，在调整所有其他患者和肿瘤相关因素后，西班牙裔女性（OR = 1.12，P = 0.014）、NHB女性（OR = 1.21，P < 0.0001）和NHAPI女性（OR = 1.73，P < 0.0001）接受乳房切除术的几率均高于NHW女性。在老年I期ER +乳腺癌患者中，自2004年以来乳房切除术比例略有下降。这些趋势主要是由NHW女性乳房切除术比例的下降推动的，但西班牙裔、NHB和NHAPI女性的乳房切除术比例仍约为25%。需要进一步研究以确定为什么与单独保乳手术相比成本更高且发病率更高的乳房切除术在老年低风险乳腺癌中没有实质性变化。
