保乳术后放疗影响因素大数据分析

虽然术后辅助放疗可以提高局部控制率和总生存率，但是许多符合条件的浸润性乳腺癌女性并未接受术后辅助放疗推荐，其影响因素尚不明确。

2018年8月6日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表美国霍普金斯医院的研究报告，通过全国癌症数据库（NCDB）分析了10年以来放疗的使用趋势，以及社会人口统计学因素对标准放疗接受率的影响。

该研究对2004～2014年70岁以下浸润性乳腺癌女性保乳术后放疗接受率的整个队列分布以及不同时期变化趋势进行分析。通过多因素逻辑回归模型，对种族、民族、医疗保险状况等因素与放疗接受率之间的相关性进行评定。

结果发现，符合分析条件患者共计50万1733例。接受辅助放疗的患者比例，由2004年的86.7%，增加至2012年的92.4%，2013年减少至2014年的88.9%。

根据单因素分析，接受放疗的比例：

白人患者高于黑人患者（90.4%比86.9%，P

非西班牙高于西班牙裔（90.2%比85.3%，P

根据多因素分析，接受放疗的显著相关因素：种族、民族、医疗保险状况、教育水平、年龄。

根据时间分析，以上差异保持稳定，随着时间的推移无显著改善。

因此，该分析结果表明，70岁以下女性接受符合指南放疗的比例近年来有所降低，保乳术后放疗差异受到种族、民族、社会经济因素持续影响，这些发现令人担忧近年来医疗服务模式的不利变化。

Breast Cancer Res Treat. 2018 Aug 6.

Impact of race, ethnicity, and socioeconomic factors on receipt of radiation after breast conservation surgery: analysis of the national cancer database.

Arti Parekh, Wei Fu, Chen Hu, Colette J. Shen, Sara Alcorn, Avani D. Rao, Fariba Asrari, Melissa S. Camp, Jean L. Wright.

Johns Hopkins Hospital, Baltimore, USA.

INTRODUCTION: Many eligible women with invasive breast cancer do not receive recommended adjuvant radiation (RT), despite its role in local control and overall survival. We examined trends in RT use over 10 years, and the impact of sociodemographic factors on the receipt of standard-of-care RT, using the National Cancer Database (NCDB).

MATERIALS/METHODS: Women under age 70 with invasive breast cancer who underwent BCS from 2004 to 2014 were analyzed. Receipt of RT was evaluated in the whole cohort and by time period to identify temporal trends. Multiple logistic regression models were used to assess associations between factors such as race, insurance status, ethnicity, and receipt of RT.

RESULTS: A total of 501,733 patients met eligibility criteria. The percentage of patients undergoing adjuvant RT increased from 86.7% in 2004 to 92.4% in 2012, and then decreased in 2013 and 2014 to 88.9%. On univariate analysis, patients of white race were significantly more likely to receive RT compared with patients of black race (90.4% vs 86.9%, p

CONCLUSIONS: This analysis suggests a recent decline in guideline-concordant receipt of RT in women under 70, and persistent disparities in the use of RT after BCS by race, ethnicity, and socioeconomic factors. These findings raise concern for a recent detrimental change in patterns of care delivery.

KEYWORDS: Adjuvant radiation Breast Disparities

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