Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH; Department of Surgery, MetroHealth System and Case Western Reserve University, Cleveland OH.
Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
Surgery. 2022 Mar;171(3):687-692. doi: 10.1016/j.surg.2021.08.061. Epub 2021 Nov 30.
The objective of this study is to examine the associations among neighborhood socioeconomic status, trimodal treatment, and disease-specific mortality among inflammatory breast cancer patients using data from the Surveillance, Epidemiology, and End Results program.
Patients diagnosed with inflammatory breast cancer (T4d) from 2010 to 2016 were identified in the Surveillance, Epidemiology, and End Results program. The cohort was stratified into neighborhood socioeconomic status groups (low, middle, high) based on National Cancer Institute census tract-level index. Trimodal treatment was defined as receipt of modified radical mastectomy, chemotherapy, and radiation therapy. Bivariable analysis, log-rank test, and a Cox proportional hazards model (hazard ratio, 95% confidence interval) were conducted to evaluate the relationship between neighborhood socioeconomic status, trimodal treatment, and disease-specific mortality.
In total, 4,374 patients met study criteria. There was no difference between the neighborhood socioeconomic status groups in receipt of trimodal treatment (P = .19). On multivariable analysis, there was no association between low neighborhood socioeconomic status (hazard ratio 1.13, 0.98-1.30; ref high neighborhood socioeconomic status) or middle neighborhood socioeconomic status (hazard ratio 1.01, 0.88-1.64; ref high neighborhood socioeconomic status) and disease-specific mortality. Notably, triple negative subtype (hazard ratio 2.66, 2.21-3.20; ref luminal A) and Black race (hazard ratio 1.41, 1.16-1.72; ref White) were associated with a higher disease-specific mortality.
For inflammatory breast cancer patients in the Surveillance, Epidemiology, and End Results program, disease-specific mortality appears to be driven by tumor biology and patient characteristics instead of treatment disparities or neighborhood socioeconomic status.
本研究旨在利用监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results，SEER）计划的数据，研究邻里社会经济地位、三联治疗与炎性乳腺癌患者疾病特异性死亡率之间的关联。
从 SEER 计划中确定了 2010 年至 2016 年间诊断为炎性乳腺癌（T4d）的患者。根据国家癌症研究所的普查地段水平指数，将队列分为邻里社会经济地位组（低、中、高）。三联治疗定义为接受改良根治性乳房切除术、化疗和放疗。采用单变量分析、对数秩检验和 Cox 比例风险模型（风险比，95%置信区间）评估邻里社会经济地位、三联治疗与疾病特异性死亡率之间的关系。
共有 4374 名患者符合研究标准。三联治疗的接受率在邻里社会经济地位组之间没有差异（P=0.19）。多变量分析显示，低邻里社会经济地位（风险比 1.13，0.98-1.30；参考高邻里社会经济地位）或中邻里社会经济地位（风险比 1.01，0.88-1.64；参考高邻里社会经济地位）与疾病特异性死亡率之间没有关联。值得注意的是，三阴性亚型（风险比 2.66，2.21-3.20；参考 luminal A）和黑人种族（风险比 1.41，1.16-1.72；参考白人）与更高的疾病特异性死亡率相关。
对于 SEER 计划中的炎性乳腺癌患者，疾病特异性死亡率似乎是由肿瘤生物学和患者特征驱动的，而不是治疗差异或邻里社会经济地位。
