Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Clin Oncol (R Coll Radiol). 2023 Sep;35(9):e549-e560. doi: 10.1016/j.clon.2023.05.016. Epub 2023 May 30.
This study examined whether patterns of post-mastectomy radiotherapy (PMRT) among women with early invasive breast cancer (EIBC) varied within England and Wales and explored the role of different patient factors in explaining any variation.
The study used national cancer data on women aged ≥50 years diagnosed with EIBC (stage I-IIIa) in England and Wales between January 2014 and December 2018 who had a mastectomy within 12 months of diagnosis. A multilevel mixed-effects logistic regression model was used to calculate risk-adjusted rates of PMRT for geographical regions and National Health Service acute care organisations. The study examined the variation in these rates within subgroups of women with different risks of recurrence (low: T1-2N0; intermediate: T3N0/T1-2N1; high: T1-2N2/T3N1-2) and investigated whether the variation was linked to patient case-mix within regions and organisations.
Among 26 228 women, use of PMRT increased with greater recurrence risk (low: 15.0%; intermediate: 59.4%; high: 85.1%). In all risk groups, use of PMRT was more common among women who had received chemotherapy and decreased among women aged ≥80 years. There was weak or no evidence of an association between use of PMRT and comorbidity or frailty, for each risk group. In women with an intermediate risk, unadjusted rates of PMRT varied substantially between geographical regions (range 40.3-77.3%), but varied less for the high-risk (range 77.1-91.6%) and low-risk groups (range 4.1-32.9%). Adjusting for patient case-mix reduced the variation in regional and organisational PMRT rates to a small degree.
Rates of PMRT are consistently high across England and Wales among women with high-risk EIBC, but variation exists across regions and organisations for women with intermediate-risk EIBC. Effort is required to reduce unwarranted variation in practice for intermediate-risk EIBC.
本研究旨在探讨英国和威尔士早期浸润性乳腺癌（EIBC）女性中保乳手术后放疗（PMRT）的模式是否存在差异，并探讨不同患者因素在解释任何差异中的作用。
本研究使用了 2014 年 1 月至 2018 年 12 月期间在英格兰和威尔士诊断为 EIBC（I-IIIa 期）且在诊断后 12 个月内接受乳房切除术的年龄≥50 岁女性的全国癌症数据。使用多水平混合效应逻辑回归模型计算地理区域和国民保健服务急性护理组织的 PMRT 风险调整率。研究还检查了这些比率在不同复发风险（低：T1-2N0；中：T3N0/T1-2N1；高：T1-2N2/T3N1-2）女性亚组中的变化，并调查了区域和组织内的患者病例组合是否与这种变化有关。
在 26228 名女性中，PMRT 的使用率随复发风险的增加而增加（低：15.0%；中：59.4%；高：85.1%）。在所有风险组中，接受化疗的女性使用 PMRT 的情况更为常见，而 80 岁以上的女性使用 PMRT 的情况则减少。对于每个风险组，PMRT 的使用与合并症或虚弱之间几乎没有或没有关联。对于中危女性，地理区域之间 PMRT 的未调整率差异很大（范围 40.3-77.3%），但高危（范围 77.1-91.6%）和低危（范围 4.1-32.9%）的差异较小。调整患者病例组合后，区域和组织内 PMRT 率的差异略有减小。
在英国和威尔士，高危 EIBC 女性中 PMRT 的使用率一直很高，但中危 EIBC 女性的区域和组织之间存在差异。需要努力减少中危 EIBC 实践中的不必要差异。
