Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients

作者：Kimmick Gretchen G^*; Camacho Fabian; Hwang Wenke; Mackley Heath; Stewart John; Anderson Roger T

来源：Journal of Geriatric Oncology, 2012, 3(2): 138-146.

DOI：10.1016/j.jgo.2012.01.004

• Breast cancer
• Breast conserving surgery
• Adjuvant radiation
• Local recurrence
• Metastases
• Survival
• Primary care
• Comorbidity
• Age

Objectives: Epidemiologic studies report that lack of adjuvant radiation (RT) after breast conserving surgery (BCS) is associated with higher short-term mortality. It is generally accepted that adjuvant RT decreases risk of breast cancer recurrence and thereby lowers long-term mortality; here, we explore reasons for its relationship to short-term mortality. %26lt;br%26gt;Materials and Methods: We studied 1583 publically insured women who had BCS between 1998 and 2002 (mean 71.8 years, range 27-101), of whom 1346 (85%) received RT. Multivariate analyses with Cox Proportional Hazards and Logistic Regression models included: age; race; comorbidity; insurance status; tumor size; number of nodes positive; hormone receptor status; receipt of radiation; adjuvant chemotherapy; preventive care - including mammography, Pap smear and primary care visits; and hospitalization. %26lt;br%26gt;Results: At a mean follow-up of 52.8 months, overall mortality was significantly lower in those who received RT (HR 0.45, p%26lt;0.0001) and higher with older age (HR 1.05, p%26lt;0.0001) and greater comorbidity (HR 1.16, p=0.0007). Local recurrence was less with receipt of optimal radiation (HR 0.47; p=0.03). Breast cancer event, as determined by a clinically logical algorithm to detect breast cancer recurrence and death, however, was not significantly associated with receipt of RT (OR 1.32, p=0.2). %26lt;br%26gt;Conclusion: These results imply that the higher short-term mortality in women not receiving RT after BCS is related to factors other than breast cancer recurrence.

• 出版日期2012-4