| 原 娜,王 磊.乳腺癌改良根治术后不同放疗模式的疗效与成本—效果分析[J].中国肿瘤,2019,28(10):797-802. |
| 乳腺癌改良根治术后不同放疗模式的疗效与成本—效果分析 |
| Effectiveness and Cost Effectiveness of Different Adjuvant Radiotherapy Modes After Radical Mastectomy in Patients with Breast Cancer |
| 投稿时间：2019-02-02 |
| DOI：10.11735/j.issn.1004-0242.2019.10.A014 |
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| 中文关键词: 乳腺癌 改良根治术 放疗模式 成本—效果分析 |
| 英文关键词:breast cancer radical mastectomy radiotherapy mode cost-benefit analysis |
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| 摘要点击次数: 3498 |
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| 中文摘要: |
| 摘 要：［目的］ 结合疗效从经济学角度对乳腺癌改良根治术后三维适形X线照射（3-D XB）和三维适形X线+电子线照射（3-D XB+EB）进行分析，为术后辅助放疗模式选择提供参考。［方法］ 选取2013年7月至2014年12月河北北方学院附属第一医院放疗科纳入的115例乳腺癌患者的临床资料及成本费用（包括放疗费用、定位费用、计划费用、模具费），所有患者均实行乳腺癌改良根治术，其中单纯改良根治术90例和新辅助化疗+改良根治术25例；采用3-D XB照射67例及3-D XB+EB照射48例；Ⅰ期11例，Ⅱ期49例，Ⅲ期55例。成本—效果分析采用成本—时间比（C/T）和增量成本—效果比（△C/△E）进行分析。采用Kaplan-Meier法计算无局部区域复发生存（LRFS）率、无远处转移生存（DMFS）率和总生存（OS）率，并应用Cox回归分析临床特征和治疗对患者预后的影响。［结果］ 中位随访时间55个月。全组病例的3年LRFS、DMFS和OS率分别为99.1%、95.7%和98.2%，其中3-D XB照射和3-D XB+EB混合照射的LRFS、OS率为100.0%和97.9%（P=0.000）、98.5%和97.9%（P=0.001），差异有统计学意义（P＜0.05），而DMFS率分别为95.5%和95.8%（P=0.951），差异无统计学意义（P＞0.05）。然而3-D XB和3-D XB+EB混合照射比较，二者在95%胸壁剂量（t=1.593，P=0.114）与锁骨上剂量（t=0.889，P=0.376）方面均无统计学差异（P＞0.05）。多因素分析显示，淋巴结转移是乳腺癌改良根治术LRFS（P=0.006，HR=0.427）、OS（P=0.010，HR=0.457）的独立预后因素，而放疗模式不是LRFS、DMFS、OS的独立预后因素（P＞0.05）。按放疗成本分析3-D XB放疗和3-D XB+EB分别为（13517.91±2260.66）元和（11940.00±2143.77）元，差异有统计学意义（P＜0.05）；而在C/T和成本-效果比（C/T/%）中差异均无统计学意义（P＞0.05），△C/△E为36.78元/月/%。［结论］ 乳腺癌改良根治术后3-D XB照射较3-D XB+EB混合照射有良好的局部控制率及生存率。从本院成本—效果来看3-D XB费用劣势不明显。淋巴结转移是影响局部控制率及生存率的高危因素。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the effectiveness and cost-effectiveness of three dimensional conformal X-ray beams(3-D XB) and 3-D XB plus electron beams(EB) adjuvant radiotherapy for breast cancer patients after modified radical mastectomy. ［Methods］ One hundred and fifteen breast cancer patients(11 for Ⅰ stage，49 for Ⅱ stage，55 for Ⅲ stage) who underwent modified radical mastectomy from July 2013 to December 2014 in the First Affiliated Hospital of Hebei North University were enrolled in the study，including 90 patients with modified radical mastectomy and 25 patients with neo-adjuvant chemotherapy(NAC) and modified radical mastectomy. After surgery 67 cases received 3-D XB adjuvant radiotherapy and 48 cases received 3-D XB combined with EB. The clinical data and cost(including radiotherapy cost，position cost，planning cost and mold cost) were collected. The cost-time(C/T) and the increased cost-effectiveness(△C/△E) were applied to analyze cost-effectiveness. Kaplan-Meier method was used to calculate the local recurrence free survival(LRFS)，distant recurrence free survival(DRFS) and overall survival(OS). The COX regression was used to analyze the correlation of clinical characters and therapy with prognosis of patients. ［Results］ Median follow-up time was 55 months. The 3-year LRFS，DRFS and OS of all patients was 99.1%，95.7% and 98.2%，respectively. The 3-year LRFS and OS in both 3-D XB and 3-D XB with EB were 100.0%，97.9%(P=0.000) and 98.5%，97.9%(P=0.001)，respectively；the 3-year DRFS of two modes was 95.5% and 95.8%(P=0.951). There were no significant differences in 95% dose for chest wall and supraclavicular region between 3-D XB and 3-D XB with EB. The multivariate analysis showed that LRFS(P=0.006，HR=0.427) and OS(P=0.010，HR=0.457) were significantly correlated with lymph metastasis，but the radiotherapy mode was not correlated with LRFS，DRFS and OS(P＞0.05). The cost analysis showed that the cost of 3-D XB and 3-D XB with EB was(13517.91±2260.66）RMB and(11940.00±2143.77) RMB，respectively(P<0.05). However，there was no significant difference in the C/T and the cost-effectiveness(C/T/%) between the two groups(P＞0.05)，the △C/△E was 36.78 RMB/M/%. ［Conclusion］ 3-D XB is better than 3-D XB combined with EB in LRFS and OS of breast cancer patients with modified radical mastectomy. From the point of cost-effectiveness，3-D XB is not inferior to 3-D XB with EB. The lymph metastasis is a significant prognosis factor in LRFS and OS. |
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