放射治疗（RT）拒绝已知对多种癌症类型的生存有不良影响。与妇科恶性肿瘤患者拒绝放射治疗相关的因素尚未得到很好的描述。本研究旨在研究妇科癌症患者记录的拒绝放射治疗的相关因素以及生存影响。本研究分析了2004年至2020年之间国家癌症数据库（NCDB）中诊断为妇科癌的患者的数据。如果患者在NCDB中的治疗医生有记录的放射治疗建议，并且患者具有完整的生存数据，那么将包括这些患者在内。使用多变量对数二项回归与鲁棒方差的方法，将在NCDB中被编码为接受放射治疗的患者与被编码为拒绝放射治疗的患者进行比较，以得出发生率比率（IRR）。使用多变量（MV）Cox比例风险模型分析总体生存（OS），以得出风险比（HR）。本研究共鉴定了209,976名患者。总计5.75%（n=12,081）的患者被编码为拒绝放射治疗。多变量IRR显示，记录了放射治疗拒绝与年龄较大（MV IRR：1.04，95% CI：1.041 - 1.045）、夏威夷原住民太平洋岛民族群体（1.72 [1.27 - 2.32]）和增加的发病率（得分=1：1.06 [1.02 - 1.11]；得分=2：1.20 [1.12 - 1.29]；得分≥ 3：1.26 [1.14 - 1.38]）呈正相关。与西班牙裔族群（0.74 [0.67 - 0.80]）有负相关性，与有保险（0.58 [0.53 - 0.63]）和年收入大于$74,063（0.85 [0.81 - 0.90]）有负相关性。统计学上显著的趋势检验（p = 0.001）表明，在16年的时间段内，放射治疗拒绝的增加。放射治疗拒绝与死亡风险显著增高相关（MV HR：1.59 [1.55 - 1.63]）。针对2004年至2020年诊断的妇科恶性肿瘤患者，记录的放射治疗拒绝增加与所有疾病类型的总体生存减少相关。有必要针对潜在的社会人口因素障碍制定有针对性的干预措施以促进放射治疗的接受。版权所有 © 2023。Elsevier Inc.出版。

Radiation (RT) refusal is known to have deleterious effects on survival for multiple cancer types. Factors associated with RT refusal by patients with gynecologic malignancies have not been well described. The study aimed to examine factors associated with and the survival impact of documented RT refusal among patients with gynecologic cancers.This study analyzed data from the National Cancer Database (NCDB) of patients with gynecologic cancers diagnosed between 2004 and 2020. Patients were included if they had complete survival data and a documented RT recommendation by their treating physician in the NCDB. Patients coded as received RT were compared to those coded as refused RT in the NCDB using a multivariate log binomial regression with robust variance to yield incidence rate ratios (IRR). Overall survival (OS) was analyzed using a multivariate (MV) Cox proportional hazards model to yield hazard ratios (HR).This study identified 209,976 patients. A total of 5.75% (n=12,081) patients were coded as refusing RT. Multivariable IRR showed that documentation of RT refusal was positively associated with older age (MV IRR: 1.04, 95% CI: 1.041 - 1.045), Native Hawaiian Pacific Islander race (1.72 [1.27 - 2.32]) and increased morbidity (score = 1: 1.06 [1.02 - 1.11]; score = 2: 1.20 [1.12 - 1.29]; score ≥ 3: 1.26 [1.14 - 1.38]). Negative associations were seen with Hispanic ethnicity (0.74 [0.67 - 0.80]), having insurance (0.58 [0.53 - 0.63]), and annual income greater than $74,063 (0.85 [0.81 - 0.90]). Over the 16-year period, a statistically significant test for trend (p = 0.001) for increasing RT refusal was noted. RT refusal was associated with significantly higher risk of death (MV HR: 1.59 [1.55 - 1.63]).For patients with gynecologic malignancies diagnosed from 2004 to 2020, an increase in documented RT refusal is associated with decreased overall survival in all disease types. Targeted interventions aimed at mitigating potential sociodemographic barriers to receipt of radiation therapy are warranted.Copyright © 2023. Published by Elsevier Inc.