Gutierrez Juan C, Koniaris Leonidas G, Cheung Michael C, Byrne Margaret M, Fischer Anne C, Sola Juan E
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Surgery. 2009 Jan;145(1):76-85. doi: 10.1016/j.surg.2008.08.011. Epub 2008 Sep 30.
The objective of this study was to define the prognostic significance of hospital surgical volume on outcomes for pediatric neuroblastoma and Wilms tumor.
The Florida Cancer Data System was examined for all pediatric patients treated between 1981 and 2004.
Of the 869 patients with neuroblastoma identified, 463 were treated at 5 high-volume centers (HVC) and 406 were treated at 61 low-volume centers (LVC). There were no differences in sex, age at diagnosis, race, ethnicity, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (70.6% and 67.7% at HVC vs 69.3% and 65.2% at LVC, P = .243). Multivariate analysis identified age at diagnosis and tumor stage as independent prognostic factors. Of the 790 patients with Wilms tumor identified, 395 were treated at 5 HVC and 395 were treated at 50 LVC. There were no differences in sex, age of diagnosis, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (91.3% and 89.9% at HVC vs 89.7% and 88.5% at LVC, P = .698). Multivariate analysis identified ethnicity, tumor stage, and use of chemotherapy as independent prognostic factors.
Survival rates for patients with neuroblastoma and Wilms tumor are unrelated to the hospital surgical volume or patient race. This result stands in stark contrast to a variety of adult malignancies. Models used for pediatric patient care for cancer may provide insight into ways to improve the treatment of adult patients in need of complex cancer care.
本研究的目的是确定医院手术量对小儿神经母细胞瘤和肾母细胞瘤预后的影响。
对1981年至2004年间接受治疗的所有小儿患者的佛罗里达癌症数据系统进行了检查。
在确诊的869例神经母细胞瘤患者中，463例在5个高手术量中心（HVC）接受治疗，406例在61个低手术量中心（LVC）接受治疗。两组在性别、诊断时年龄、种族、民族或疾病分期方面无差异。治疗组之间的5年和10年生存率相同（HVC组分别为70.6%和67.7%，LVC组分别为69.3%和65.2%，P = 0.243）。多变量分析确定诊断时年龄和肿瘤分期为独立的预后因素。在确诊的790例肾母细胞瘤患者中，395例在5个HVC接受治疗，395例在50个LVC接受治疗。两组在性别、诊断年龄或疾病分期方面无差异。治疗组之间的5年和10年生存率相同（HVC组分别为91.3%和89.9%，LVC组分别为89.7%和88.5%，P = 0.698）。多变量分析确定民族、肿瘤分期和化疗的使用为独立的预后因素。
神经母细胞瘤和肾母细胞瘤患者的生存率与医院手术量或患者种族无关。这一结果与多种成人恶性肿瘤形成鲜明对比。用于小儿癌症患者护理的模型可能为改善需要复杂癌症护理的成人患者的治疗方法提供见解。
