Background: The National Comprehensive Cancer Network guidelines were designed to improve patient outcomes. Here, we examine factors that may contribute to outcomes and guideline adherence in patients with triple-negative breast cancer. Methods: This was a retrospective cohort study of women with triple-negative breast cancer using the California Cancer Registry. Adherent treatment was defined as the receipt of a combination of surgery, lymph node assessment, adjuvant radiation, and/or chemotherapy. A multivariable logistic regression was used to determine the effects of independent variables on adherence to the NCCN guidelines. Disease-specific survival was calculated using Cox regression analysis. Results: A total of 16,858 women were analyzed. Black and Hispanic patients were less likely to receive guideline-adherent care (OR 0.82, 95%CI 0.73–0.92 and OR 0.87, 95%CI 0.79–0.95, respectively) compared to White patients. Hazard ratios adjusted for adherent care showed that Black patients had increased disease-specific mortality (HR 1.28, 95%CI 1.16–1.42,p< 0.0001) compared to White patients. Conclusions: A significant majority of breast cancer patients in California continue to receive non-guideline-adherent care. Non-Hispanic Black patients and patients from lower SES quintile groups were less likely to receive guideline-adherent care. Patients with non-adherent care had worse disease-specific survival compared to recipients of NCCN guideline-adherent care.
背景：美国国家综合癌症网络指南旨在改善患者预后。本研究探讨可能影响三阴性乳腺癌患者预后及指南依从性的相关因素。方法：本研究基于加利福尼亚癌症登记处的数据，对三阴性乳腺癌女性患者进行回顾性队列分析。指南依从性治疗定义为接受手术、淋巴结评估、辅助放疗和/或化疗的联合治疗方案。采用多变量逻辑回归分析确定自变量对NCCN指南依从性的影响，并通过Cox回归分析计算疾病特异性生存率。结果：共纳入16,858例女性患者分析。与白人患者相比，黑人和西班牙裔患者接受指南依从性治疗的可能性更低（OR值分别为0.82[95%CI 0.73-0.92]和0.87[95%CI 0.79-0.95]）。经依从性治疗调整后的风险比显示，黑人患者的疾病特异性死亡率较白人患者显著升高（HR 1.28，95%CI 1.16-1.42，p<0.0001）。结论：加利福尼亚州绝大多数乳腺癌患者仍接受非指南依从性治疗。非西班牙裔黑人患者及社会经济地位较低分位组的患者接受指南依从性治疗的可能性更低。与非指南依从性治疗患者相比，接受NCCN指南依从性治疗的患者具有更好的疾病特异性生存率。
肿瘤(癌症)患者之家