接受区域淋巴结照射的乳腺癌患者的经济毒性：不同亚型的差异

Financial toxicity in breast cancer patients receiving regional nodal irradiation: Variation by cancer subtype

BREAST

影响因子:7.9

分区:医学2区 / 妇产科学2区肿瘤学2区

发表日期:2024 Dec

作者: Grace L Smith, Benjamin D Smith, Chi-Fang Wu, Simona F Shaitelman, Mariana Chavez-MacGregor, Rashmi Murthy, Kelsey Kaiser, Kimberly S Ku, Julia J Shi, Sanjay S Shete, Ying-Shiuan Chen, Robert J Volk, Sharon H Giordano, Ya-Chen T Shih, Karen E Hoffman

DOI: 10.1016/j.breast.2024.103813

摘要

我们评估了具有较高风险临床因素、需要区域淋巴结照射（RNI）的乳腺癌患者中，社会人口学和临床预测的经济毒性（FT）。在一项比较常规与低分割治疗的临床试验中，183名参与者中有125人（68%）完成了由验证的《癌症中的经济压力与韧性》（ENRICh）工具测得的FT初步调查，评分范围为0（最低）至10（最严重）。通过皮尔森相关系数、Kruskal-Wallis检验、Mann-Whitney U检验和Jonckheere-Terpstra检验评估预测因素的相关性。采用多变量逻辑回归检验严重FT（ENRICh≥5）的预测因素，计算优势比（OR）并转换为相对风险（RR）。样本中，所有患者均接受了RNI，92%接受了化疗，67%进行了腋窝淋巴结清扫，26%接受了不伴重建的乳房切除术，32%接受了伴重建的乳房切除术。随访中位时间为1.48年，FT中位评分为2.13（四分位距0.93-4.6），有20.8%的患者经历了严重FT。未经调整的分析显示，较差的FT评分与年龄较小（P=0.003）、西班牙裔（P=0.006）、收入较低（P=0.02）、诊断到FT评估的时间较短（P=0.02）以及接受化疗（P=0.05）有关，但与乳腺手术类型（P=0.42）、腋窝手术类型（P=0.33）或病理T、N分期（P=0.68、0.47）无关。在多变量分析中，三阴性亚型是预测严重FT的唯一临床因素（RR=3.38；95% CI，1.48-4.99；P=0.01）。在接受RNI的乳腺癌患者中，三阴性亚型与严重FT相关，提示肿瘤受体亚型可能有助于早期FT干预的关键乳腺癌亚群的识别。

Abstract

We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI).Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR).Of the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93-4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48-4.99; P = 0.01).Among patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.