局部晚期乳腺癌改良根治术后两种辅助放化疗模式的疗效与成本效果分析

The efficacy and cost effectiveness analysis of two adjuvant chemoradiotherapy modes after modified radical mastectomy in locally advanced breast cancer

目的:结合疗效从经济学角度对局部晚期乳腺癌改良根治术后FEC-T后程同步放疗和序贯放疗模式进行分析,为术后辅助治疗模式选择提供参考。方法:采用成本-效果分析对155例改良根治术后接受FEC-T后程同步放疗或序贯放疗的局部晚期乳腺癌病例进行疗效评价及成本效果分析。结果:中位随访39个月。与序贯模式比较,后程同步放疗模式未增加不良反应;缩短平均治疗时间6.2周,改善3年无复发生存率(92.3%vs 81.8%,P=0.046),有改善3年的无疾病进展生存率和总生存率趋势;3年无疾病进展生存率的成本-效果比,后程同步模式为999.96元/%,序贯模式为1 349.31元/%,增量成本-效果比为-889.38元/%。结论:改良根治术后FEC-T后程同步放疗模式及序贯放疗模式都具有良好耐受性及疗效。后程同步放疗模式有更好的疾病控制及成本-效果比,可作为局部晚期乳腺癌的改良根治后辅助治疗模式的良好选择。

Objective：Combined with evaluation of the efficacy to analyze FEC-T chemotherapy late course concurrent radiotherapy and sequential radiotherapy from the perspective of economics,provide a reference for postoperative adjuvant therapy mode selection for locally advanced breast cancer after modified radical mastectomy.Methods：With cost-effectiveness analysis method,155 locally advanced breast cancer patients underwent FEC-T late course concurrent radiotherapy or sequential radiotherapy after radical surgery were evaluated on efficacy and cost effectiveness.Results：In median follow-up of 39 months,compared with the sequential mode,mode of late course concurrent radiotherapy didn＇t increase adverse effects.It shorten processing average time about 6.2 weeks and improve the rate of 3-year locoregional recurrence-free survival（ 92.3% vs 81.8%,P = 0.046）.It also had the improvement trend of the rate of 3-year disease-free survival survival or the rate of overall survival rates and a better cost-benefit ratio（ 999.96 yuan / % vs 1349.31 yuan / %,the incremental cost effectiveness was-889.38 yuan / %.Conclusion：After modified radical mastectomy,FEC-T late course concurrent radiotherapy models and sequential patterns have good tolerability and efficacy.Late course concurrent radiotherapy models have better disease control and cost-effect ratio.It can be used as good choices of adjuvant treatment model after modified radical mastectomy in locally advanced breast cancer.