Socioeconomic differences in survival among breast cancer patients in the Netherlands not explained by tumor size
Socioeconomic differences in survival among breast cancer patients in the Netherlands not explained by tumor size
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DOI：
10.1007/s10549-010-1250-z
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发表时间：
2011-06-01
影响因子：
3.8
通讯作者：
Liefers, G. J.
中科院分区：
文献类型：
--
作者：
Bastiaannet, E.;de Craen, A. J. M.;Liefers, G. J.
女性乳腺癌患者的生存率似乎存在社会经济差异，通常与疾病的较高阶段有关。然而，尚未研究肿瘤大小的差异。本研究的目的是根据社会经济地位 (SES) 评估荷兰女性乳腺癌患者的生存差异，并根据肿瘤大小和诊断时的分期进行分层。所有被诊断患有乳腺癌的女性（1995-2005 年）均选自荷兰癌症登记处。根据邮政编码将患者连接到 SES 数据库。使用多变量逻辑回归来评估与 SES 相关的因素。计算总生存期（OS）和相对生存期（RS）。总体而言，共纳入 127,599 名患者。较高的 SES 与较低的 T 期相关（P < 0.0001）。研究发现，SES 较低的患者的生存率（OS 和 RS）较低。同样在不同体型的群体中，RS 也不同。总体而言，高 SES 组的 10 年 OS 为 65%，低 SES 组为 58%（风险比 1.1，P < 0.001），RS 分别为 79% 和 74%（相对超额风险，RER 1.2；P < 0.001）。调整年龄、诊断年份、分级、TNM 分期和治疗后，社会经济差异仍然具有统计学显着性（P < 0.001）。对于社会经济地位最低的群体来说，可以避免 777 人死亡。在荷兰观察到乳腺癌患者生存率的社会经济差异。 SES 较低的患者在诊断时分期较高只能部分解释生存率下降的原因。旨在减少社会经济健康不平等的政策对于提高乳腺癌的生存率可能很重要。
There seem to be socioeconomically differences in survival for females with breast cancer, usually associated with a higher stage of disease. However, differences within tumor size have not been studied. Aim of this study is to assess differences in survival according to socioeconomic status (SES), stratified for tumor size and stage at diagnosis, for females with breast cancer in the Netherlands. All females diagnosed with breast cancer (1995-2005) were selected from the Netherlands Cancer Registry. Patients were linked to a SES database according to postal code. A multivariable logistic regression was used to assess factors associated with SES. Overall survival (OS) and relative survival (RS) were calculated. Overall, 127,599 patients were included. Higher SES was associated with lower T-stage (P < 0.0001). A decreased survival (OS and RS) was found for patients with a lower SES. Also within different size groups, RS was different. Overall, 10-year OS for the high SES group was 65 and 58% for the low SES group (hazard ratio 1.1, P < 0.001) and RS was 79 versus 74% (relative excess risk, RER 1.2; P < 0.001). The socioeconomic differences remained statistically significant (P < 0.001) after adjustment for age, year of diagnosis, grade, TNM stage, and treatment. For the lowest SES group 777 deaths could be avoided. Socioeconomic differences in survival of breast cancer patients were observed in the Netherlands. Higher stage at diagnosis of patients with a lower SES only partly explains the decreased survival. Policies aimed at the reduction of socioeconomic health inequalities might be important to improve survival of breast cancer.