Perry Nikhita J, Sharon Cimarron E, Tortorello Gabriella N, Ma Kevin L, Straker Richard J, Fayanju Oluwadamilola M, Tchou Julia C, Miura John T, Karakousis Giorgos C
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Surgery. 2023 Oct;174(4):794-800. doi: 10.1016/j.surg.2023.07.004. Epub 2023 Aug 8.
Although historic studies of state registries have demonstrated decreased radiation therapy use for patients with breast cancer living further away from radiation facilities, the association between travel distance and breast cancer treatment in a modern national cohort remains unknown.
Female patients with estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 negative pathologic stages I to II breast cancer were identified from the National Cancer Database (2018-2020) and dichotomized by distance ≤20 miles or >20 miles (75th percentile) from the treatment facility. The association between travel distance and type of surgery and treatment administered was analyzed by univariate and multivariate logistic regression and after 1:1 propensity matching.
Of the 293,318 patients identified for inclusion, the median age was 63 years, and most patients (n = 190,567, 65%) lived ≤20 miles of the treatment facility. Patients with a travel burden >20 miles were more likely to receive a mastectomy (≤20 miles 30.4% vs >20 miles 34.0%, P < .001; odds ratio 1.14, P = .016), and less likely to receive radiation (≤20 miles 63.3% vs >20% miles 60.1%, P < .001; odds ratio 0.81, P < .001). These findings persisted after propensity score matching (n = 33,544 per cohort), with patients living further being more likely to undergo a mastectomy (≤20 miles 30.3% vs >20 miles 35.3%, P < .001) and less likely to receive radiation (≤ 20 miles 65.4% vs. >20 miles 58.5%, P < .001).
Patients with hormone receptor-positive stage I to II breast cancer with a larger travel burden are more likely to receive a mastectomy and less likely to undergo radiation therapy to treat their disease.
尽管既往对州登记处的研究表明，居住在距离放疗设施较远地区的乳腺癌患者接受放疗的比例有所下降，但在现代全国队列中，旅行距离与乳腺癌治疗之间的关联仍不清楚。
从国家癌症数据库（2018 - 2020年）中识别出雌激素受体/孕激素受体阳性且人表皮生长因子受体2阴性的Ⅰ至Ⅱ期病理类型乳腺癌女性患者，并根据距离治疗机构≤20英里或>20英里（第75百分位数）进行二分法分类。通过单因素和多因素逻辑回归以及1:1倾向匹配分析旅行距离与手术类型和所接受治疗之间的关联。
在确定纳入的293,318例患者中，中位年龄为63岁，大多数患者（n = 190,567，65%）居住在距离治疗机构≤20英里的范围内。旅行负担>20英里的患者更有可能接受乳房切除术（≤20英里为30.4%，>20英里为34.0%，P < 0.001；比值比1.14，P = 0.016），而接受放疗的可能性较小（≤20英里为63.3%，>20英里为60.1%，P < 0.001；比值比0.81，P < 0.001）。在倾向得分匹配后（每组n = 33,544），这些结果仍然存在，居住距离更远的患者更有可能接受乳房切除术（≤20英里为30.3%，>20英里为35.3%，P < 0.001），而接受放疗的可能性较小（≤20英里为65.4%，>20英里为58.5%，P < 0.001）。
旅行负担较大的激素受体阳性Ⅰ至Ⅱ期乳腺癌患者更有可能接受乳房切除术，而接受放射治疗以治疗其疾病的可能性较小。
