Refusal of Radiation Results in Inferior Survival in Endometrial Cancer.
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
23
2
2020
medline:
7
8
2020
entrez:
22
2
2020
Statut:
ppublish
Résumé
We sought to understand factors associated with refusal of adjuvant radiotherapy in endometrial cancer and its impact on outcomes. Data from the National Cancer Database for patients who underwent surgery for nonmetastatic endometrial cancer between 2004 and 2015 were pooled. The Pearson χ test and multivariate logistic regression analyses were used to assess demographic, clinical, and treatment factors. Inverse probability of treatment weighting was used to account for differences in baseline characteristics. Kaplan-Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival (OS). We identified 4739 of 80,803 patients (5.9%) who refused radiotherapy. Factors associated with refusal were: no insurance (relative risk [RR]=1.66, P<0.01), Medicare (RR=1.42, P<0.01), living >50 miles from treatment (RR=1.34, P<0.01), Charlson-Deyo Comorbidity Scores of 1 (RR=1.16, P<0.01) or ≥2 RR=1.38, P<0.01), age above 60 years (RR=1.28, P<0.01), International Federation of Gynecology and Obstetrics (FIGO) stages IIIA (RR=1.63, P<0.01) and IIIC (RR=1.65, P<0.01) disease, papillary (RR=1.69, P<0.01) and clear cell histology (RR=1.64, P<0.01). Factors associated with radiation therapy receipt included: Hispanic race (RR=0.61, P<0.01), income >$63,000 (RR=0.89, P=0.044), undergoing chemotherapy (RR=0.17, P<0.01), FIGO stages IB (RR=0.81, P<0.01) and II (RR=0.70, P<0.01) disease, and lymphadenectomy (RR=0.79, P<0.01). After weighting, 5-year OS was significantly lower with refusal (74.3% vs. 79.7%, P<0.01). This survival decrement was maintained across FIGO stages. We identified characteristics associated with radiation refusal, including socioeconomic barriers, advanced disease stage, and histology. Refusal of radiotherapy conferred decreased OS across FIGO stages.
Identifiants
pubmed: 32079851
doi: 10.1097/COC.0000000000000681
pii: 00000421-202006000-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
399-410Références
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