College of Medicine, 124506University of Central Florida/HCA Consortium- Ocala, Ocala, FL, USA.
23703Ocala Regional Medical Center, Ocala, FL, USA.
Am Surg. 2022 Sep;88(9):2141-2147. doi: 10.1177/00031348221093761. Epub 2022 Apr 29.
Studies have reported differences between age, socioeconomic status, treatment facility, and tumor burden based on survival outcomes for breast cancer (BC). The goal of this study is to evaluate BC survival and mortality outcomes by facility type. To examine likely influence of evidence-based practices, these groups were then sub stratified by pre- and post-Z0011 trial.
This is a population-based study using the National Cancer Database of Commission on Cancer (CoC) designated centers. Intergroup comparisons of demographics were performed using chi-square test. Kaplan-Meier curve and Cox Hazard Ratios were used to evaluate survival differences. Multivariable regression methods were used to evaluate risk-adjusted 30- and 90-day mortality among BC patients. A difference-in-difference (DiD) analysis was used to evaluate the change of treatment over time pre- and post-Z0011 trial.
Median survival was highest among comprehensive community facilities at 63.2 months and integrated community facilities at 62.7 months, while the lowest for community and academic facilities at 60.6 months and 61 months. Academic facilities had the lowest 30- and 90-day mortality. Community centers saw the largest improvement in overall mortality post-Z0011 trial. The benefit after the Z0011 trial was evident among community centers at the 90-day mortality period as their decrease in mortality (-1.7%) was significantly lower than the decrease of mortality among academic centers (-1.3%), -value = .01.
While the Z0011 trial had a positive influence in both community and academic facilities, community programs benefited the most. Z0011 trial showed the most change in practice for the community centers.
研究报告根据乳腺癌（BC）的生存结果报告了年龄、社会经济地位、治疗机构和肿瘤负担方面的差异。本研究的目的是按机构类型评估 BC 的生存和死亡率结果。为了检查基于证据的实践的可能影响，这些组随后按 Z0011 试验前后进行了细分。
这是一项基于人群的研究，使用了美国癌症协会（CoC）指定中心的国家癌症数据库。使用卡方检验对组间人口统计学数据进行比较。使用 Kaplan-Meier 曲线和 Cox 风险比评估生存差异。使用多变量回归方法评估 BC 患者的风险调整 30 天和 90 天死亡率。使用差异中的差异（DiD）分析评估 Z0011 试验前后治疗时间的变化。
综合社区机构的中位生存时间最高，为 63.2 个月，综合社区机构为 62.7 个月，而社区和学术机构的生存时间最低，为 60.6 个月和 61 个月。学术机构的 30 天和 90 天死亡率最低。社区中心在 Z0011 试验后整体死亡率的改善最大。Z0011 试验后的获益在 90 天死亡率期间在社区中心明显，因为它们的死亡率下降（-1.7%）明显低于学术中心的死亡率下降（-1.3%），p 值=0.01。
虽然 Z0011 试验对社区和学术机构都有积极的影响，但社区项目受益最大。Z0011 试验对社区中心的实践改变最大。
