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【JNCI】乳腺癌复发风险可能取决于外科医生(Vo
Dick AW, Sorbero MS, Ahrendt GM, Hayman JA, Gold HT, Schiffhauer L, Stark A, Griggs JJ.
J Natl Cancer Inst. 2011 Jan 3. [Epub ahead of print]
http://jnci.oxfordjournals.org/content/early/2011/01/03/jnci.djq499
Background The high incidence of ductal carcinoma in situ (DCIS) and variations in its treatment motivate inquiry into the comparative effectiveness of treatment options. Few such comparative effectiveness studies of DCIS, however, have been performed with detailed information on clinical and treatment attributes.
Methods We collected detailed clinical, nonclinical, pathological, treatment, and long-term outcomes data from multiple medical records of 994 women who were diagnosed with DCIS from 1985 through 2000 in Monroe County (New York) and the Henry Ford Health System (Detroit, MI). We used ipsilateral disease-free survival models to characterize the role of treatments (surgery and radiation therapy) and margin status (positive, close [<2 mm], or negative [≥2 mm]) and logistic regression models to characterize the determinants of treatments and margin status, including the role of surgeons. All statistical tests were two-sided.
Results Treatments and margin status were statistically significant and strong predictors of long-term disease-free survival, but results varied substantially by surgeon. This variation by surgeon accounted for 15%-35% of subsequent ipsilateral 5-year recurrence rates and for 13%-30% of 10-year recurrence rates. The overall differences in predicted 5-year disease-free survival rates for mastectomy (0.993), breast-conserving surgery with radiation therapy (0.945), and breast-conserving surgery without radiation therapy (0.824) were statistically significant (P(diff) < .001 for each of the differences). Similarly, each of the differences at 10 years was statistically significant (P < .001).
Conclusions Our work demonstrates the contributions of treatments and margin status to long-term ipsilateral disease-free survival and the link between surgeons and these key measures of care. Although variation by surgeon could be generated by patients' preferences, the extent of variation and its contribution to long-term health outcomes are troubling. Further work is required to determine why women with positive margins receive no additional treatment and why margin status and receipt of radiation therapy vary by surgeon.
nagement and the Roles of Margins and Surgeons.pdf (451.43k) 在线查看 Comparative Effectiveness of Ductal Carcinoma In Situ Management and the Roles of Margins and Surgeons.
导管原位癌治疗的比较效应及边缘和外科医生的影响
Background The high incidence of ductal carcinoma in situ (DCIS) and variations in its treatment motivate inquiry into the comparative effectiveness of treatment options. Few such comparative effectiveness studies of DCIS, however, have been performed with detailed information on clinical and treatment attributes.
背景：导管原位癌(DCIS)的高发病率和治疗多样化促使人们探究各种治疗的比较效应。但很少有基于临床和治疗属性的详细信息而进行DCIS的比较效应研究。
Methods We collected detailed clinical, nonclinical, pathological, treatment, and long-term outcomes data from multiple medical records of 994 women who were diagnosed with DCIS from 1985 through 2000 in Monroe County (New York) and the Henry Ford Health System (Detroit, MI). We used ipsilateral disease-free survival models to characterize the role of treatments (surgery and radiation therapy) and margin status (positive, close [<2 mm], or negative [≥2 mm]) and logistic regression models to characterize the determinants of treatments and margin status, including the role of surgeons. All statistical tests were two-sided.
方法：从1985-2000年在门罗县（纽约）和亨利-福特卫生系统（底特律，密歇根州）确诊DCIS的994位女性的多种医疗记录中，我们收集了详细的临床、非临床、病理学、治疗以及长期疗效的数据。我们用同侧无病生存模型对治疗（手术和放疗）作用和边缘状况(阳性, 接近 [<2 mm], 或阴性 [≥2 mm])进行分析，用logistic回归模型对包括外科医生因素在内的治疗和边缘状况的决定因素进行分析。所有统计学检验均为双侧检验。
Results Treatments and margin status were statistically significant and strong predictors of long-term disease-free survival, but results varied substantially by surgeon. This variation by surgeon accounted for 15%-35% of subsequent ipsilateral 5-year recurrence rates and for 13%-30% of 10-year recurrence rates. The overall differences in predicted 5-year disease-free survival rates for mastectomy (0.993), breast-conserving surgery with radiation therapy (0.945), and breast-conserving surgery without radiation therapy (0.824) were statistically significant (P(diff) < .001 for each of the differences). Similarly, each of the differences at 10 years was statistically significant (P < .001).
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作者:admin@医学,生命科学 2011-01-12 23:25
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