Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival
Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival
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DOI：
10.1016/j.ijrobp.2006.03.048
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发表时间：
2006-08-01
影响因子：
7
通讯作者：
Neugut, Alfred I.
中科院分区：
文献类型：
--
作者：
Hershman, Dawn L.;Wang, Xiaoyan;Neugut, Alfred I.
目的：乳腺癌诊断的延迟与晚期和生存率低有关，但肿块切除术和放射治疗（RT）开始之间的时间间隔的重要性尚未得到很好的研究。我们调查的因素，影响乳房肿瘤切除术和RT之间的时间间隔，间隔和survival.Patients和方法之间的关联：我们使用的数据从监测，流行病学和最终结果（SEER）-医疗数据库的妇女年龄在65岁及以上，诊断为I-II期乳腺癌，1991年和1999年之间。在没有接受化疗的患者中，我们研究了与肿瘤切除术和RT开始之间的时间间隔相关的因素，以及延迟与生存的相关性，使用线性回归和考克斯比例风险modeling.Results：在24，833例接受肿瘤切除术的妇女中，13，907例（56%）接受了RT。年龄大、黑人、晚期、合并症多和未婚与手术和RT之间的时间间隔较长相关。早期开始RT没有益处;然而，延迟> 3个月与总死亡率较高相关（风险比，1.92; 95%置信区间，1.64-2.24）和癌症特异性死亡率（风险比3.84; 95%可信区间3.01-4.91）结论：令人放心的是，早期开始RT与生存率无关。虽然> 3个月的延迟并不常见，但它们与生存率低相关。这种关联是否是因果关系或由于混杂因素，如不良的健康行为，是未知的;直到它被更好地理解，应努力及时启动RT。(c)2006年爱思唯尔公司
Purpose: Delays in the diagnosis of breast cancer are associated with advanced stage and poor survival, but the importance of the time interval between lumpectomy and initiation of radiation therapy (RT) has not been well studied. We investigated factors that influence the time interval between lumpectomy and RT, and the association between that interval and survival.Patients and Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database on women aged 65 years and older, diagnosed with Stages I-II breast cancer, between 1991 and 1999. Among patients who did not receive chemotherapy, we studied factors associated with the time interval between lumpectomy and the initiation of RT, and the association of delay with survival, using linear regression and Cox proportional hazards modeling.Results: Among 24,833 women with who underwent lumpectomy, 13,907 (56%) underwent RT. Among those receiving RT, 97% started treatment within 3 months; older age, black race, advanced stage, more comorbidities, and being unmarried were associated with longer time intervals between surgery and RT. There was no benefit to earlier initiation of RT; however, delays > 3 months were associated with higher overall mortality (hazard ratio, 1.92; 95% confidence interval, 1.64-2.24) and cancer-specific mortality (hazard ratio, 3.84; 95% confidence interval 3.01-4.91).Conclusions: Reassuringly, early initiation of RT was not associated with survival. Although delays of > 3 months are uncommon, they are associated with poor survival. Whether this association is causal or due to confounding factors, such as poor health behaviors, is unknown; until it is better understood, efforts should be made to initiate RT in a timely fashion. (c) 2006 Elsevier Inc.