Patterns of locoregional treatment for nonmetastatic breast cancer by patient and health system factors.
Patterns of locoregional treatment for nonmetastatic breast cancer by patient and health system factors.
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患者和卫生系统因素对非转移性乳腺癌的局部治疗模式。
DOI：
10.1002/cncr.29092
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发表时间：
2015
期刊：
影响因子：
6.2
通讯作者：
Lipscomb,Joseph
中科院分区：
文献类型：
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作者：
Anderson,RogerT;Morris,CylleneR;Kimmick,Gretchen;Trentham-Dietz,Amy;Camacho,Fabian;Wu,Xiao-Cheng;Sabatino,SusanA;Fleming,StevenT;Lipscomb,Joseph
背景：这项研究的目的是通过美国国家癌症登记项目(疾病控制和预防中心)的护理乳腺癌和前列腺癌模式研究(POCBP)来检查非转移性乳腺癌的局部最终治疗。方法在7个州/地区登记系统(佐治亚州、北卡罗来纳州、肯塔基州、路易斯安那州、威斯康星州、明尼苏达州和加利福尼亚州)重新提取SPOCBP病历数据，以验证数据质量和评估人群中的治疗模式。国家综合癌症网络临床实践治疗指南与美国癌症联合委员会诊断时的分期相一致，以评估护理。结果在9142名登记确认的乳腺癌患者中，655名患者被编码为具有0到IIIA期肿瘤的原发病，并纳入了这项研究。大约88%的患者接受了符合指南的局部区域治疗。然而，这一结果因年龄组不同而不同：接受指导治疗的50岁女性和70岁≥女性的比例分别为92%和80%(P<； 0.01)。在接受者操作曲线分析中，对接受(否/是)符合指南的护理的最佳区分特征是接受保乳手术与乳房切除术(C = 0.70)、患者年龄(C = 0.62)、较大的肿瘤分期(C = 0.60)、公共保险(C = 0.58)以及至少存在轻度合并症(C = 0.55)。BCS后的放射治疗(RT)是在研究人群中导致不一致的最被省略的治疗部分。在多因素回归分析中，治疗机构、导管原位癌、种族和合并症对不协调护理的影响因年龄组而异。结论乳腺癌标准疗法未得到充分利用的特征因年龄组和BCS使用而异，有遗漏RT的风险。癌症2015；121：790-799。
BACKGROUNDThe purpose of this study was to examine local definitive therapy for nonmetastatic breast cancer with the Patterns of Care Breast and Prostate Cancer (POCBP) study of the National Program of Cancer Registries (Centers for Disease Control and Prevention).METHODSPOCBP medical record data were re‐abstracted in 7 state/regional registry systems (Georgia, North Carolina, Kentucky, Louisiana, Wisconsin, Minnesota, and California) to verify data quality and assess treatment patterns in the population. National Comprehensive Cancer Network clinical practice treatment guidelines were aligned with American Joint Committee on Cancer staging at diagnosis to appraise care.RESULTSSix thousand five hundred five of 9142 patients with registry‐confirmed breast cancer were coded as having primary disease with stage 0 to IIIA tumors and were included in the study. Approximately 88% received guideline‐concordant locoregional treatment. However, this outcome varied by age group: 92% of women < age 50 versus 80% of women ≥ age 70 years old received guideline care (P< 0.01). Characteristics that best discriminated receipt (no/yes) of guideline‐concordant care in receiver operating curve analyses were the receipt of breast‐conserving surgery (BCS) versus mastectomy (C = 0.70), patient age (C = 0.62), a greater tumor stage (C = 0.60), public insurance (C = 0.58), and the presence of at least mild comorbidity (C = 0.55). Radiation therapy (RT) after BCS was the most omitted treatment component causing nonconcordance in the study population. In multivariate regression, the effects of the treatment facility, ductal carcinoma in situ, race, and comorbidity on nonconcordant care differed by age group.CONCLUSIONSPatterns of underuse of standard therapies for breast cancer vary by age group and BCS use, with which there is a risk of omission of RT.Cancer2015;121:790–799.©2014 American Cancer Society.