Paulson Emily Carter, Mitra Nandita, Sonnad Seema, Armstrong Katrina, Wirtalla Christopher, Kelz Rachel Rapaport, Mahmoud Najjia N
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Surg. 2008 Oct;248(4):675-86. doi: 10.1097/SLA.0b013e318187a757.
Although National Cancer Institute (NCI) designation as a cancer center is based almost solely on research activities, it is often viewed, by patients and referring providers, as an indication of clinical excellence.
To compare the short- and long-term outcomes of colon and rectal cancer surgery performed at NCI-designated centers to the outcomes after resection at non-NCI-designated hospitals.
We performed a retrospective cohort study of Survival, Epidemiology, and End Results (SEER)-Medicare database patients undergoing segmental colectomy (n = 33,969) or proctectomy (n = 8591) for cancer from 1996-2003. Multivariate logistic regression, with and without propensity scores, and matched conditional regression were performed to evaluate the relationship between NCI status and postoperative mortality (in-hospital or 30-day death). The log-rank test, Kaplan-Meier curves, and Cox regression compared survival between hospital types.
We evaluated 33,969 colectomy and 8591 proctectomy patients. Postoperative mortality after colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality after proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics. For both colon and rectal cancer patients, long-term mortality was significantly improved after resection at NCI centers (HR 0.84, P < 0.001; HR 0.85, P = 0.02, respectively).
NCI designation is associated with lower risk of postoperative death and improved long-term survival. Possible factors responsible for these benefits include surgeon training, multidisciplinary care, and adherence to treatment guidelines. Studies are underway to elucidate the factors leading to improved patient outcomes.
尽管美国国立癌症研究所（NCI）将某机构指定为癌症中心几乎完全基于其研究活动，但患者及转诊医疗服务提供者通常将其视为临床卓越的标志。
比较在NCI指定中心进行的结肠癌和直肠癌手术的短期及长期结局与在非NCI指定医院进行切除术后的结局。
我们对1996年至2003年期间在监测、流行病学和最终结果（SEER）-医疗保险数据库中因癌症接受节段性结肠切除术（n = 33,969）或直肠切除术（n = 8591）的患者进行了一项回顾性队列研究。进行了多因素逻辑回归分析（有和没有倾向评分）以及匹配条件回归分析，以评估NCI状态与术后死亡率（住院期间或30天内死亡）之间的关系。采用对数秩检验、Kaplan-Meier曲线和Cox回归比较不同医院类型之间的生存率。
我们评估了33,969例结肠切除术患者和8591例直肠切除术患者。非NCI中心结肠切除术后的死亡率为6.7%，NCI中心为3.2%。直肠切除术后的死亡率分别为5.0%和1.9%。在对患者和医院特征进行调整后，这些差异具有统计学意义。对于结肠癌和直肠癌患者，在NCI中心进行切除术后长期死亡率均显著改善（风险比分别为0.84，P < 0.001；0.85，P = 0.02）。
NCI指定与较低的术后死亡风险和改善的长期生存相关。促成这些益处的可能因素包括外科医生培训、多学科护理以及对治疗指南的遵循。目前正在进行研究以阐明导致患者结局改善的因素。
