COVID-19 大流行对新发乳腺癌患者临床表现、治疗和结局的影响：一项回顾性多中心队列研究。
Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study.
机构信息
Assistance Publique-Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France.
CentraleSupélec, Laboratoire Génie Industriel, Université Paris-Saclay, Gif-sur-Yvette, France.
出版信息
Cancer Med. 2023 Nov;12(22):20918-20929. doi: 10.1002/cam4.6637. Epub 2023 Nov 1.
BACKGROUND
The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic.
METHODS
We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020.
RESULTS
In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups.
CONCLUSIONS
Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.
背景
SARS-CoV-2 大流行扰乱了医疗体系。我们比较了大流行前后新乳腺癌（BC）的癌症分期。
方法
我们在巴黎大区大学医院（AP-HP）的数据仓库中对多中心回顾性队列研究的数据进行了分析。我们确定了 2019 年和 2020 年所有新诊断为 BC 的女性患者。我们评估了她们治疗轨迹的时间、初始肿瘤分期和接受的治疗：BC 切除术、单纯全身治疗、单纯放疗或单纯最佳支持治疗（BSC）。我们计算了患者的 1 年总生存率（OS），并比较了 2019 年和 2020 年的指标。
结果
2019 年和 2020 年分别有 2055 例和 1988 例新 BC 患者接受了癌症治疗，在两次封锁期间，与 2019 年相比，BC 诊断分别减少了 18%和增加了 23%。新诊断的转移性肿瘤（15%和 15%，p=0.95）、1332 例接受初始切除术和 296 例接受新辅助治疗的患者的 pTNM 和 ypTNM 分布没有差异（p=0.37，p=0.3）。从第一次多学科会议到治疗的中位时间为 19 天（四分位距 11-39 天）和 35 天（四分位距 22-65 天），没有差异。接受整形手术（15%和 17%，p=0.08）和治疗类别没有差异：肿瘤切除术（73%和 72%）、单纯全身治疗（13%和 14%）、单纯放疗（9%和 9%）、单纯 BSC（5%和 5%）（p=0.8）。在接受切除术的患者中，新辅助治疗率在 2019 年（16%）低于 2020 年（20%）（p=0.02）。1 年 OS 率分别为 99.3%和 98.9%（HR=0.96；95%CI，0.77-1.2）、72.6%和 76.6%（HR=1.28；95%CI，0.95-1.72）、96.6%和 97.8%（HR=1.09；95%CI，0.61-1.94）和 15.5%和 15.1%（HR=0.99；95%CI，0.72-1.37），在治疗组中。
结论
尽管新诊断的 BC 数量有所减少，但肿瘤分期没有变化，OS 也没有差异。
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