Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy
Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy
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DOI：
10.1038/sj.bjc.6602747
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发表时间：
2005-09-05
影响因子：
8.8
通讯作者：
Willemse, PHB
中科院分区：
文献类型：
--
作者：
Schaapveld, M;de Vries, EGE;Willemse, PHB
这项以人群为基础的研究旨在分析在引入前哨淋巴结活检(SNB)前后，早期乳腺癌应用放射治疗和腋窝淋巴结清扫(ALND)的手术治疗和指南遵从性的变化。这项研究包括了1989-2002年间确诊的13532名连续接受手术治疗的I-IIIA期乳腺癌患者。医院的保乳手术(BCS)比率差异很大，T1肿瘤的保乳率在27%到72%之间，T2肿瘤的保乳术率在14%和42%之间。在多变量分析中，在对病例组合进行校正后，BCS比率仍然存在明显的医院间和时间依赖的差异。老年患者的指南遵从性明显较低。在年龄<75岁的患者中，25.2%的患者遗漏了ALND或放射治疗。在SNB后没有ALND的患者比例从1999年的1.8%增加到2002年的37.8%。然而，在2002年，SNB阳性的患者中也有12.2%没有ALND。自瑞士央行推出以来，BCS在放射治疗和ALND方面的指南遵从性从2000年前的96.1%下降到2002年的91.4%(P
This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I - IIIA breast cancer patients diagnosed in 1989 - 2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged >= 75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not have an ALND. Guideline compliance for BCS, with respect to radiotherapy and ALND, fell since the SNB introduction, from 96.1% before 2000 to 91.4% in 2002 (P