Nationwide Trends in Mastectomy for Early-Stage Breast Cancer
Nationwide Trends in Mastectomy for Early-Stage Breast Cancer
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DOI：
10.1001/jamasurg.2014.2895
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发表时间：
2015-01-01
期刊：
影响因子：
16.9
通讯作者：
Hooks, Mary A.
中科院分区：
文献类型：
--
作者：
Kummerow, Kristy L.;Du, Liping;Hooks, Mary A.
重要性美国经认证的乳腺中心是根据大多数早期乳腺癌妇女的保乳手术（BCS）的表现来衡量的。在区域和有限的国家队列的先前研究表明，最近转向增加乳房切除术在符合BCS的患者中的表现。目的为了检查符合BCS的患者的乳房切除率是否随着时间的推移在全国范围内增加，并且与乳房重建和单侧疾病双侧乳房切除术的同步增加有关。和参与者我们进行了一项回顾性队列研究，使用多变量logistic回归模型对早期乳腺癌乳房切除术的时间趋势进行了分析，以调整相关的协变量和相互作用。我们研究了120多万名成年女性，这些女性从1998年1月1日到2011年12月31日在美国癌症协会和美国外科医生学会癌症委员会认可的中心接受治疗，使用国家癌症数据库。次要结果指标包括乳房再造和单侧疾病双侧乳房切除术的时间趋势。结果：研究队列中共有35.5%的患者接受了乳房切除术。在该队列的最近8年中，符合BCS条件的女性中乳房切除术的调整比值增加了34%，2011年相对于2003年的比值比为1.34（95%CI，1.31-1.38）。在临床淋巴结阴性疾病（比值比，1.38; 95%CI，1.34-1.41）和原位疾病（比值比，2.05; 95%CI，1.95-2.15）的女性中，增加率最高。在接受乳房切除术的女性中，乳房再造率从1998年的11.6%增加到2011年的36.4%（趋势P <0.001）。单侧疾病的双侧乳房切除率从1998年的1.9%增加到2011年的11.2%（P < .001）。结论和相关性在过去的十年中，有明显的趋势，接受乳房切除术，乳房再造和双侧乳房切除术的BCS合格患者比例较高。最大的增加是在淋巴结阴性和原位疾病的妇女中看到的。乳房切除率尚未超过目前美国癌症协会/美国外科医生学会癌症认证基准。需要进一步的研究来了解与这些趋势相关的因素及其对美国癌症协会/美国外科医生委员会癌症中心绩效测量的影响。
IMPORTANCE Accredited breast centers in the United States are measured on performance of breast conservation surgery (BCS) in the majority of women with early-stage breast cancer. Prior research in regional and limited national cohorts suggests a recent shift toward increasing performance of mastectomy in patients eligible for BCS.OBJECTIVE To examine whether mastectomy rates in patients eligible for BCS are increasing over time nationwide, and are associated with coincident increases in breast reconstruction and bilateral mastectomy for unilateral disease.DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study of temporal trends in performance of mastectomy for early-stage breast cancer using multivariable logistic regression modeling to adjust for pertinent covariates and interactions. We studied more than 1.2 million adult women treated at centers accredited by the American Cancer Society and the American College of Surgeons Commission on Cancer from January 1, 1998, to December 31, 2011, using the National Cancer Data Base.EXPOSURES Year of breast cancer diagnosis.MAIN OUTCOMES AND MEASURES Proportion of women with early-stage breast cancer who underwent mastectomy. Secondary outcome measures include temporal trends in breast reconstruction and bilateral mastectomy for unilateral disease.RESULTS A total of 35.5% of the study cohort underwent mastectomy. The adjusted odds of mastectomy in BCS-eligible women increased 34% during the most recent 8 years of the cohort, with an odds ratio of 1.34 (95% CI, 1.31-1.38) in 2011 relative to 2003. Rates of increase were greatest in women with clinically node-negative disease (odds ratio, 1.38; 95% CI, 1.34-1.41) and in situ disease (odds ratio, 2.05; 95% CI, 1.95-2.15). In women undergoing mastectomy, rates of breast reconstruction increased from 11.6% in 1998 to 36.4% in 2011 (P < .001 for trend). Rates of bilateral mastectomy for unilateral disease increased from 1.9% in 1998 to 11.2% in 2011 (P < .001).CONCLUSIONS AND RELEVANCE In the past decade, there have been marked trends toward higher proportions of BCS-eligible patients undergoing mastectomy, breast reconstruction, and bilateral mastectomy. The greatest increases are seen in women with node-negative and in situ disease. Mastectomy rates do not yet exceed current American Cancer Society/American College of Surgeons Commission on Cancer accreditation benchmarks. Further research is needed to understand factors associated with these trends and their implications for performance measurement in American Cancer Society/American College of Surgeons Commission on Cancer centers.