Department of Breast Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, No.10, Zhenhai Road, Xiamen, 361003, Fujian Province, China.
Radiat Oncol. 2023 Aug 5;18(1):130. doi: 10.1186/s13014-023-02297-2.
Although radiotherapy after breast-conserving surgery has been the standard treatment for breast cancer, some people still refuse to undergo radiotherapy. The aim of this study is to identify risk factors for refusal of radiotherapy after breast-conserving surgery.
To investigate the trend of refusing radiotherapy after breast-conserving surgery in patients with breast cancer using the Surveillance, Epidemiology, and End Results database. The patients were divided into radiotherapy group and radiotherapy refusal group. Survival results were compared using a multivariate Cox risk model adjusted for clinicopathological variables. Multivariate logistic regression was used to analyze the influencing factors of patients refusing radiotherapy after breast-conserving surgery and a nomogram model was established.
The study included 87,100 women who underwent breast-conserving surgery for breast cancer between 2010 and 2015. There were 84,948 patients (97.5%) in the radiotherapy group and 2152 patients (2.5%) in the radiotherapy refusal group. The proportion of patients who refused radiotherapy after breast-conserving surgery increased from 2.1% in 2010 to 3.1% in 2015. The Kaplan-Meier survival curve showed that radiotherapy can improve overall survival (p < 0.001) and breast cancer specific survival (p < 0.001) in the patients with breast-conserving surgery. The results of multivariate logistic regression showed that age, income, marital status, race, grade, stage, subtype and chemotherapy were independent factors associated with the refusal of radiotherapy.
Postoperative radiotherapy can improve the benefits of breast-conserving surgery. Patients with old age, low income, divorce, white race, advanced stage, and no chemotherapy were more likely to refuse radiotherapy.
尽管保乳手术后的放疗一直是乳腺癌的标准治疗方法，但仍有一些人拒绝接受放疗。本研究旨在确定保乳手术后拒绝放疗的危险因素。
利用监测、流行病学和最终结果数据库调查乳腺癌患者保乳手术后拒绝放疗的趋势。将患者分为放疗组和放疗拒绝组。使用多变量 Cox 风险模型调整临床病理变量比较生存结果。采用多变量逻辑回归分析保乳手术后拒绝放疗的患者的影响因素，并建立列线图模型。
本研究纳入了 2010 年至 2015 年间接受保乳手术治疗的 87100 名乳腺癌女性患者。其中 84948 例患者（97.5%）在放疗组，2152 例患者（2.5%）在放疗拒绝组。保乳手术后拒绝放疗的患者比例从 2010 年的 2.1%增加到 2015 年的 3.1%。Kaplan-Meier 生存曲线显示，放疗可以提高保乳手术患者的总生存率（p<0.001）和乳腺癌特异性生存率（p<0.001）。多变量逻辑回归的结果表明，年龄、收入、婚姻状况、种族、分级、分期、亚型和化疗是与拒绝放疗相关的独立因素。
术后放疗可以提高保乳手术的获益。年龄较大、收入较低、离婚、白种人、晚期和未接受化疗的患者更有可能拒绝放疗。
