Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA.
Ann Surg Oncol. 2020 Aug;27(8):2614-2625. doi: 10.1245/s10434-020-08326-8. Epub 2020 Mar 17.
To optimize breast cancer care, the American College of Surgeons Commission on Cancer developed quality measures regarding receipt and timing of adjuvant radiotherapy (RT). Nationwide compliance with these measures and its impact on overall survival (OS) are evaluated herein.
Patients (n = 285,291) diagnosed with invasive breast cancer from 2004 to 2012 were identified from the National Cancer Database. Compliance with RT administration within 365 days from diagnosis was determined for patients with stage III disease with ≥ 4 positive lymph nodes post mastectomy and stage I-III disease post breast-conserving surgery (BCS). Univariate and multivariate logistic regression and Cox proportional hazard models were used to assess factors associated with compliance and OS, respectively.
In the mastectomy cohort, 66.9% received timely RT, showing improved OS versus no RT patients (HR 0.70, 95% CI 0.67-0.73). Delayed RT patients (≥ 365 days) achieved equivalent OS to those receiving timely RT (HR 1.07, 95% CI 0.93-1.23) and superior OS to no RT patients (HR 0.74, 95% CI 0.65-0.85). In the BCS cohort, 89.4% received timely RT, showing improved OS versus no RT patients (HR 0.47, 95% CI 0.45-0.49). Delayed RT was associated with improved OS versus no RT (HR 0.64, 95% CI 0.56-0.74) and decreased OS versus timely RT (HR 1.37, 95% CI 1.19-1.58). Factors associated with noncompliance included insurance type and distance to hospital.
Quality measure compliance with adjuvant RT improves OS, regardless of timing after mastectomy. However, timeliness does impact OS after BCS. Focus on modifiable factors to improve compliance such as access to care may lead to improved compliance and OS.
为了优化乳腺癌的护理，美国外科医师学院癌症委员会制定了关于接受和辅助放疗（RT）时间的质量标准。本文评估了全国范围内这些措施的依从性及其对总生存率（OS）的影响。
从国家癌症数据库中确定了 2004 年至 2012 年间诊断为浸润性乳腺癌的 285291 名患者。对接受乳房切除术的 III 期疾病（术后有≥4 个阳性淋巴结）和接受保乳手术（BCS）的 I-III 期疾病的患者，确定了从诊断之日起 365 天内接受 RT 治疗的依从性。使用单变量和多变量逻辑回归和 Cox 比例风险模型分别评估与依从性和 OS 相关的因素。
在乳房切除术队列中，66.9%的患者及时接受了 RT，与未接受 RT 的患者相比，OS 得到改善（HR 0.70，95%CI 0.67-0.73）。延迟 RT 患者（≥365 天）的 OS 与及时接受 RT 的患者相当（HR 1.07，95%CI 0.93-1.23），优于未接受 RT 的患者（HR 0.74，95%CI 0.65-0.85）。在 BCS 队列中，89.4%的患者及时接受了 RT，与未接受 RT 的患者相比，OS 得到改善（HR 0.47，95%CI 0.45-0.49）。延迟 RT 与未接受 RT 相比，OS 得到改善（HR 0.64，95%CI 0.56-0.74），与及时 RT 相比，OS 降低（HR 1.37，95%CI 1.19-1.58）。与不依从相关的因素包括保险类型和与医院的距离。
无论乳房切除术的时间如何，接受辅助 RT 的质量标准的依从性都可以提高 OS。然而，及时性确实会影响 BCS 后的 OS。关注改善依从性的可改变因素，例如获得护理的机会，可能会提高依从性和 OS。
