Hillner B E, Penberthy L, Desch C E, McDonald M K, Smith T J, Retchin S M
Massey Cancer Center, Virginia Commonwealth University, Richmond VA 23298, USA.
Breast Cancer Res Treat. 1996;40(1):75-86. doi: 10.1007/BF01806004.
Few studies of practice variation in the management of early breast cancer for elderly women have examined the process of care in depth. This study evaluated the effects of age and other factors on surgical staging techniques and treatment.
Virginia cancer registry data were linked with Medicare claims and 1990 census data. The sample included all newly diagnosed patients with pathologic confirmed local and regional breast cancer in 1985-1989 (n = 3,361). Analyses included descriptive univariate statistics and multiple logistic regression analysis for staging and treatment alternatives. Process of care variables included tumor size determination, axillary lymph node dissection, use of adjuvant therapy, and radiation if breast conserving surgery (BCS) was performed.
About 75 percent of women had tumor size and axillary node dissection. Increasing comorbidity was associated with a lower likelihood of axillary node dissection. Nine percent of local compared to 44 percent of regional disease patients received adjuvant therapy. Hormonal therapy increased from 13 percent of women in 1985-1988 to 24 percent in 1989. Hormonal therapy did not vary with patient age. One-third of the patients with positive lymph nodes compared to 8 percent of node negative women received hormonal therapy. Blacks were more likely to present with advanced disease. A logistic regression model evaluated the multiple effects of patients and clinical characteristics: older women were more likely to present with larger tumors, were less likely to have axillary node dissections, and were less likely to receive chemotherapy or radiation.
Younger age was most consistently associated with staging and the use of chemotherapy in this cohort of elderly breast cancer patients. Based on the reported initial treatment plan, hormonal therapy was infrequently used and information from axillary lymph node assessment was used to stratify treatment. Although the low use of adjuvant hormonal therapy in elderly women may compromise survival, neither comorbid nor socioeconomic factors as measured in this study explained this practice pattern.
针对老年女性早期乳腺癌治疗中实践差异的研究很少深入考察护理过程。本研究评估了年龄及其他因素对手术分期技术和治疗的影响。
弗吉尼亚癌症登记数据与医疗保险理赔数据及1990年人口普查数据相关联。样本包括1985 - 1989年所有新诊断的经病理证实为局部和区域乳腺癌的患者（n = 3361）。分析包括描述性单变量统计以及用于分期和治疗选择的多因素逻辑回归分析。护理过程变量包括肿瘤大小测定、腋窝淋巴结清扫、辅助治疗的使用，以及如果进行保乳手术（BCS）则包括放疗。
约75%的女性进行了肿瘤大小测定和腋窝淋巴结清扫。合并症增加与腋窝淋巴结清扫的可能性降低相关。局部疾病患者中9%接受了辅助治疗，而区域疾病患者中这一比例为44%。激素治疗从1985 - 1988年女性中的13%增加到1989年的24%。激素治疗与患者年龄无关。淋巴结阳性患者中有三分之一接受了激素治疗，而淋巴结阴性女性中这一比例为8%。黑人更有可能表现为晚期疾病。一个逻辑回归模型评估了患者和临床特征的多种影响：老年女性更有可能表现为较大肿瘤，进行腋窝淋巴结清扫的可能性较小，接受化疗或放疗的可能性也较小。
在这组老年乳腺癌患者中，年龄较小最常与分期及化疗的使用相关。根据报告的初始治疗计划，激素治疗使用较少，且腋窝淋巴结评估信息用于分层治疗。尽管老年女性辅助激素治疗使用不足可能会影响生存，但本研究中测量的合并症和社会经济因素均无法解释这种实践模式。
