Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011
Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011
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DOI：
10.1001/jama.2014.10707
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发表时间：
2014-09-03
影响因子：
120.7
通讯作者：
Gomez, Scarlett L.
中科院分区：
文献类型：
--
作者：
Kurian, Allison W.;Lichtensztajn, Daphne Y.;Gomez, Scarlett L.
双侧乳房切除术越来越多地用于治疗单侧乳腺癌。因为它可能有医疗和心理社会并发症，更好地了解其使用和结果是必不可少的，以优化癌症care. ObjectiveTo比较使用和死亡率后，双侧乳房切除术，保乳治疗与放射治疗，单侧乳房切除术。参与者是1998年至2011年在加州诊断为O-III期单侧乳腺癌的女性，中位随访时间为89.1个月。主要结果和测量与手术使用相关的因素（多分类logistic回归）;总体死亡率和乳腺癌特异性死亡率结果在189734例乳腺癌患者中，双侧乳房切除率从2.0%上升到2.0%（P <0.01），双侧乳房切除率从2.0%上升到2.0%（P <0.01），双侧乳房切除率从2.0%上升到2.0%（P <0.01），双侧乳房切除率从2.0%上升到2.0%（P <0.01）。（95%CI，1.7%-2.2%）1998年至12.3%（95%CI，11.8%-12.9%），年增长14.3%（95% CI，13.1%-15.5%）;在40岁以下的女性中，该比率从1998年的3.6%（95% CI，2.3%-5.0%）增加到2011年的33%（95% CI，29.8%-36.5%）。非西班牙裔白色妇女、有私人保险的妇女和在国家癌症研究所（NCI）指定的癌症中心接受治疗的妇女更常采用双侧乳房切除术（NCI癌症中心患者中为8.6%[95%CI，8.1%-9.2%]，非NCI癌症中心患者中为6.0% [95%CI，5.9%-6.1%];比值比[OR]，1.13 [95%CI，1.04-1.22]）;相反，单侧乳房切除术更常用于少数种族/民族（菲律宾裔，52.8%[95% CI，51.6%-54.0%]; OR，2.00 [95% CI，1.90-2.11]和西班牙裔，45.6%[95% CI，45.0%-46.2%]; OR，1.16 [95% CI，1.13-1.20] vs非西班牙裔白色人，35.2% [95% CI，34.9%-35.5%]）和有公共/医疗补助保险的患者（48.4%[95% CI，47.8%-48.9%]; OR，1.08 [95% CI，1.05-1.11] vs私人保险，36.6%[95% CI，36.3%-36.8%]）。与保乳手术加放疗（10年死亡率，16.8%[95% CI，16.6%-17.1%]）相比，单侧乳房切除术与更高的全因死亡率相关（风险比[HR]，1.35 [95% CI，1.32-1.39]; 10年死亡率，20.1%[95% CI，19.9%-20.4%]）。与双侧乳房切除术相比，死亡率无显著差异（HR，1. 02 [95% CI，0. 94 - 1. 11]; 10年死亡率，18. 8%[95% CI，18. 6%-19. 0%]）。从1998年到2011年，加州双侧乳房切除术的使用显著增加，并且与保乳手术加放疗相比，死亡率较低。单侧乳房切除术的死亡率高于其他两种手术选择。
IMPORTANCE Bilateral mastectomy is increasingly used to treat unilateral breast cancer. Because it may have medical and psychosocial complications, a better understanding of its use and outcomes is essential to optimizing cancer care.OBJECTIVE To compare use of and mortality after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy.DESIGN, SETTING, AND PARTICIPANTS Observational cohort study within the population-based California Cancer Registry; participants were women diagnosed with stages O-III unilateral breast cancer in California from 1998 through 2011, with median follow-up of 89.1 months. MAINOUTCOMES AND MEASURES Factors associated with surgery use (from polytomous logistic regression); overall and breast cancer-specific mortality (from propensity score weighting and Cox proportional hazards analysis).RESULTS Among 189 734 patients, the rate of bilateral mastectomy increased from 2.0% (95% CI, 1.7%-2.2%) in 1998 to 12.3%(95% CI, 11.8%-12.9%) in 2011, an annual increase of 14.3%(95% CI, 13.1%-15.5%); among women younger than 40 years, the rate increased from 3.6%(95% CI, 2.3%-5.0%) in 1998 to 33%(95% CI, 29.8%-36.5%) in 2011. Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute (NCI)-designated cancer center (8.6%[95% CI, 8.1%-9.2%] among NCI cancer center patients vs 6.0% [95% CI, 5.9%-6.1%] among non-NCI cancer center patients; odds ratio [OR], 1.13 [95% CI, 1.04-1.22]); in contrast, unilateral mastectomy was more often used by racial/ethnic minorities (Filipina, 52.8%[95% CI, 51.6%-54.0%]; OR, 2.00 [95% CI, 1.90-2.11] and Hispanic, 45.6%[95% CI, 45.0%-46.2%]; OR, 1.16 [95% CI, 1.13-1.20] vs non-Hispanic white, 35.2% [95% CI, 34.9%-35.5%]) and those with public/Medicaid insurance (48.4%[95% CI, 47.8%-48.9%]; OR, 1.08 [95% CI, 1.05-1.11] vs private insurance, 36.6%[95% CI, 36.3%-36.8%]). Compared with breast-conserving surgery with radiation (10-year mortality, 16.8%[95% CI, 16.6%-17.1%]), unilateral mastectomy was associated with higher all-cause mortality (hazard ratio [HR], 1.35 [95% CI, 1.32-1.39]; 10-year mortality, 20.1%[95% CI, 19.9%-20.4%]). There was no significant mortality difference compared with bilateral mastectomy (HR, 1.02 [95% CI, 0.94-1.11]; 10-year mortality, 18.8% [95% CI, 18.6%-19.0%]). Propensity analysis showed similar results.CONCLUSIONS AND RELEVANCE Use of bilateral mastectomy increased significantly throughout California from 1998 through 2011 and was not associated with lower mortality than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than were the other 2 surgical options.