Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials.
Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials.
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DOI：
10.1002/pon.2094
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发表时间：
2013-02
期刊：
影响因子：
3.6
通讯作者：
Paskett, Electra D.
中科院分区：
文献类型：
--
作者：
Herndon, James E., II;Kornblith, Alice B.;Holland, Jimmie C.;Paskett, Electra D.
本文旨在调查由癌症和白血病组B进行的10项研究中，社会经济地位（以教育程度衡量）对接受治疗的乳腺癌患者生存率的影响。患者在试验入组时报告了社会人口统计学数据，包括教育。根据治疗组/研究分层的考克斯比例风险模型用于检查教育对早期和转移性乳腺癌患者生存率的影响，调整已知的预后因素后。患者人群包括1020例转移性疾病患者和5146例早期疾病患者。在转移性患者中，最终多变量模型中与生存率较差相关的因素包括非裔美国人种族、未婚、雌激素受体阴性、既往激素治疗、内脏受累和骨骼受累。在早期患者中，与较差生存率相关的重要因素包括非洲裔美国人种族、分居/丧偶、绝经后/围绝经期、阴性/未知雌激素受体状态、阴性孕激素受体状态、>4个阳性淋巴结、肿瘤直径>2 cm和教育。未完成高中学业与早期患者的生存率较差相关。在转移性患者中，缺乏高中学历的非非洲裔美国妇女的生存率低于其他非非洲裔美国妇女，缺乏高中教育的非非洲裔美国妇女的生存率高于受过教育的非非洲裔美国妇女。在参加临床试验的早期乳腺癌患者中，受教育程度低于高中是死亡的一个危险因素，其对转移性患者的影响尚不清楚。试验后生存计划需要关注社会地位低的妇女，如教育程度。
This paper aims to investigate the effect of socioeconomic status, as measured by education, on the survival of breast cancer patients treated on 10 studies conducted by the Cancer and Leukemia Group B. Sociodemographic data, including education, were reported by the patient at trial enrollment. Cox proportional hazards model stratified by treatment arm/study was used to examine the effect of education on survival among patients with early stage and metastatic breast cancer, after adjustment for known prognostic factors. The patient population included 1020 patients with metastatic disease and 5146 patients with early stage disease. Among metastatic patients, factors associated with poorer survival in the final multivariable model included African American race, never married, negative estrogen receptor status, prior hormonal therapy, visceral involvement, and bone involvement. Among early stage patients, significant factors associated with poorer survival included African American race, separated/widowed, post/perimenopausal, negative/unknown estrogen receptor status, negative progesterone receptor status, >4 positive nodes, tumor diameter >2 cm, and education. Having not completed high school was associated with poorer survival among early stage patients. Among metastatic patients, non-African American women who lacked a high school degree had poorer survival than other non-African American women, and African American women who lacked a high school education had better survival than educated African American women. Having less than a high school education is a risk factor for death among patients with early stage breast cancer who participated in a clinical trial, with its impact among metastatic patients being less clear. Post-trial survivorship plans need to focus on women with low social status, as measured by education.
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