Treatment trends and factors associated with survival in T1aN0 and T1bN0 breast cancer patients
Treatment trends and factors associated with survival in T1aN0 and T1bN0 breast cancer patients
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DOI：
10.1245/s10434-007-9441-5
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发表时间：
2007-10-01
影响因子：
3.7
通讯作者：
Winchester, David P.
中科院分区：
文献类型：
--
作者：
Kennedy, Timothy;Stewart, Andrew K.;Winchester, David P.
背景：雌激素受体阳性乳腺癌的保乳治疗(BCT)和辅助激素治疗已成为标准治疗方案。我们的目标是评估早期乳腺癌手术治疗和辅助治疗的趋势，并确定预测生存的因素。方法：利用国家癌症数据库(NCDB)，对1993-2004年间淋巴结阴性乳腺癌患者(T1aN0M0和T1bN0M0)进行鉴定。对1993-1994年、1998-1999年和2003-2004年这三个时期进行比较，以分析手术治疗和辅助治疗的趋势。结果：共确诊T1aN0M0或T1bN0M0乳腺癌123,212例。保乳手术的使用率从1993/1994年的61.3%上升到2003/2004年的78.3%，同时乳房切除术的使用率也随之下降。放射治疗的使用率也从1993/1994年的51.9%上升到2003/2004年的62.0%。应用辅助激素治疗的比例从1993/1994年的26.7%大幅上升到2003/2004年的44.7%。在调整了潜在的混杂因素后，T1a(94.3%)和T1b(93.1%)肿瘤的5年生存率差异不大(P=0.04)。年龄、级别、大小和未接受放射治疗和激素治疗的BCS患者死亡的可能性较高。结论：BCS的使用率随着时间的推移而增加，但考虑到该队列中肿瘤的小体积和符合BCT的患者的百分比，乳腺癌切除率仍然可以被认为是很高的。在过去的十年中，激素疗法的使用显著增加。如果要增加BCT和激素治疗的利用率，则需要对影响治疗选择的患者和医生因素进行进一步调查。
Background: Breast conservation therapy (BCT) and adjuvant hormonal therapy for estrogen-receptor positive breast cancers have become standard of care. Our objectives were to evaluate trends in the surgical management and adjuvant therapy for early-stage breast cancer and to identify factors predicting survival.Methods: Using the National Cancer Data Base (NCDB), patients with node-negative breast cancers less than 1 cm (T1aN0M0 and T1bN0M0) from 1993-2004 were identified. The time periods of 1993-1994, 1998-1999, and 2003-2004 were compared to analyze trends in surgical management and adjuvant therapy. Cox Proportional Hazards modeling was used to examine factors predicting survival.Results: Overall, 123,212 cases of T1aN0M0 or T1bN0M0 breast cancer were identified. The use of breast conservation surgery increased from 61.3% in 1993/1994 to 78.3% in 2003/2004 with a concomitant decrease in the use of mastectomy. The use of radiation therapy also increased from 51.9% in 1993/1994 to 62.0% in 2003/2004. Adjuvant hormonal therapy administration rose sharply from 26.7% in 1993/1994 to 44.7% in 2003/2004. After adjusting for potential confounders, the difference in 5-year survival rates for T1a (94.3%) and T1b (93.1%) tumors was marginal (P = .04). Age, grade, size, and failure of BCS patients to receive radiation therapy and hormonal therapy were independent predictors of a higher likelihood of death.Conclusions: BCS utilization increased over time, but mastectomy rates may still be considered high given the small size of tumors in this cohort and the percent of patients eligible for BCT. The use of hormonal therapy increased significantly over the past decade. Further investigation into patient and physician factors affecting treatment choices is needed if BCT and hormonal therapy utilization is to increase.