SEER-Medicare联合NCDB大型临床数据库研究登上JA

作者: 医科研 | 来源:发表于2020-03-17 07:20 被阅读0次

摘要

重要性

Time to surgery（TTS）的重要性是患者和临床医生关注的问题，但围绕其对乳腺癌存活率的影响存在争议。几乎没有国家数据评估该其联系。

目的

通过对美国2个最大的癌症数据库进行单独分析，研究从诊断到乳腺癌手术时间与生存率之间的关系。

设计，设置和参与者

进行了两项独立的基于人群的研究，这些研究是从监测，流行病学和最终结果（SEER）-医疗保险相关数据库和国家癌症数据库（NCDB）中前瞻性收集的国家数据。 SEER-Medicare队列包括65岁以上的Medicare患者，而NCDB队列包括在美国全美经癌症委员会认可的设施接受护理的患者。每次分析均通过评估5个间隔（≤30、31-60、61-90、91-120和121-180天）和特定疾病的60天间隔评估了总生存率与诊断和手术时间之间的关系。所有患者均被诊断出患有非炎性，非转移性，浸润性乳腺癌，并接受了手术作为初始治疗。

主要结果和衡量指标

根据患者，人口统计学和肿瘤相关因素进行调整后，总体生存率和特定疾病生存率随诊断和手术时间的变化而变化。

结果

SEER-Medicare队列在1992年至2009年之间诊断出94 544名66岁或以上的患者。随着延迟时间的增加，总体生存率总体降低（危险比[HR]为1.09; 95％CI为1.06-1.13; P <.001），以及患有I期疾病（HR，1.13; 95％CI，1.08-1.18; P <.001）和II期疾病（HR 1.06; 95％CI，1.01-1.11; P = .01）的患者。乳腺癌特异性死亡率每隔60天增加一次（子分布危险比[sHR]为1.26； 95％CI为1.02-1.54； P = .03）。 NCDB的研究评估了2003年至2005年诊断为18岁或以上的115-790名患者。每个增加的时间间隔，总死亡率HR为1.10（95％CI，1.07-1.13； P <0.001），在第一阶段（HR，1.16）显着；在调整了人口统计学，肿瘤和治疗因素后；仅95％CI，1.12-1.21； P; <。001）和II（HR，1.09； 95％CI，1.05-1.13； P <.001）。

结论和相关性

更高的TTS与较低的总体生存率和特定疾病的生存率相关，而延迟时间的缩短与可与某些标准疗法媲美的收益相关。尽管术前评估和考虑其他方案（如重建术）需要时间，但应尽可能降低TTS，以提高生存率。

Abstract

Importance Time to surgery (TTS) is of concern to patients and clinicians, but controversy surrounds its effect on breast cancer survival. There remains little national data evaluating the association.

Objective To investigate the relationship between the time from diagnosis to breast cancer surgery and survival, using separate analyses of 2 of the largest cancer databases in the United States.

Design, Setting, and Participants Two independent population-based studies were conducted of prospectively collected national data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare–linked database and the National Cancer Database (NCDB). The SEER-Medicare cohort included Medicare patients older than 65 years, and the NCDB cohort included patients cared for at Commission on Cancer–accredited facilities throughout the United States. Each analysis assessed overall survival as a function of time between diagnosis and surgery by evaluating 5 intervals (≤30, 31-60, 61-90, 91-120, and 121-180 days) and disease-specific survival at 60-day intervals. All patients were diagnosed with noninflammatory, nonmetastatic, invasive breast cancer and underwent surgery as initial treatment.

Main Outcomes and Measures Overall and disease-specific survival as a function of time between diagnosis and surgery, after adjusting for patient, demographic, and tumor-related factors.

Results The SEER-Medicare cohort had 94 544 patients 66 years or older diagnosed between 1992 and 2009. With each interval of delay increase, overall survival was lower overall (hazard ratio [HR], 1.09; 95% CI, 1.06-1.13; P < .001), and in patients with stage I (HR, 1.13; 95% CI, 1.08-1.18; P < .001) and stage II disease (HR 1.06; 95% CI, 1.01-1.11; P = .01). Breast cancer–specific mortality increased with each 60-day interval (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.54; P = .03). The NCDB study evaluated 115 790 patients 18 years or older diagnosed between 2003 and 2005. The overall mortality HR was 1.10 (95% CI, 1.07-1.13; P < .001) for each increasing interval, significant in stages I (HR, 1.16; 95% CI, 1.12-1.21; P < .001) and II (HR, 1.09; 95% CI, 1.05-1.13; P < .001) only, after adjusting for demographic, tumor, and treatment factors.

Conclusions and Relevance Greater TTS is associated with lower overall and disease-specific survival, and a shortened delay is associated with benefits comparable to some standard therapies. Although time is required for preoperative evaluation and consideration of options such as reconstruction, efforts to reduce TTS should be pursued when possible to enhance survival.