Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA.
Department of Biomedical Informatics, University of Pittsburg, Pittsburg, Pennsylvania, USA.
J Surg Oncol. 2022 Sep;126(3):433-442. doi: 10.1002/jso.26901. Epub 2022 Apr 22.
BACKGROUND: The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and receipt of low-value breast cancer procedures. METHODS: Patients with breast cancer diagnosed between 2010 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER) Program. Low value procedures included: (1) axillary lymph node dissection (ALND) for patients with limited nodal disease receiving breast conservation therapy (BCT); (2) contralateral prophylactic mastectomies (CPM); and (3) sentinel lymph node biopsies (SLNB) in patients ≥70 years old with clinically node negative early-stage hormone-positive breast cancer. The cohort was divided by nSES. Univariable and multivariable logistic regression analysis compared the groups. RESULTS: The study included 412 959 patients. Compared to patients in high nSES areas, residing in neighborhoods with low nSES (odd ratio [OR] 2.20, 95% confidence interval [CI] 2.0-2.42) and middle nSES (OR 1.42, 95% CI 1.20-1.56) was associated with a higher probability of undergoing low value ALND. Conversely, patients in low SES neighborhoods were less likely to receive low value SLNB (OR 0.89, 95% CI 0.85-0.94) or CPM than (low nSES OR 0.75, 95% CI 0.73-0.77); middle nSES OR 0.91 (0.89-0.92) those in high SES neighborhoods. CONCLUSION: In the SEER Program, low nSES was associated with a lower probability of low value procedures except for ALND utilization.
背景:本研究旨在探讨社区社会经济地位(nSES)与接受低价值乳腺癌治疗之间的关联。
方法:在监测、流行病学和最终结果(SEER)计划中,确定了 2010 年至 2016 年间被诊断患有乳腺癌的患者。低价值治疗包括:(1)接受保乳治疗(BCT)的局部淋巴结疾病有限的患者的腋窝淋巴结清扫术(ALND);(2)对临床阴性早期激素阳性乳腺癌且年龄≥70 岁的患者进行预防性对侧乳房切除术(CPM);(3)前哨淋巴结活检术(SLNB)。根据 nSES 将队列分为不同组。使用单变量和多变量逻辑回归分析比较组间差异。
结果:本研究纳入了 412959 名患者。与高 nSES 地区的患者相比,居住在低 nSES(比值比 [OR] 2.20,95%置信区间 [CI] 2.0-2.42)和中 nSES(OR 1.42,95% CI 1.20-1.56)社区的患者接受低价值 ALND 的可能性更高。相反,低 SES 社区的患者接受低价值 SLNB(OR 0.89,95% CI 0.85-0.94)或 CPM 的可能性较低(低 nSES OR 0.75,95% CI 0.73-0.77);中 nSES OR 0.91(0.89-0.92)低于高 SES 社区的患者。
结论:在 SEER 计划中,低 nSES 与低价值治疗的可能性降低有关,但 ALND 的使用除外。
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