基于容积的口咽癌患者手术治疗趋势。

Volume-based trends in surgical care of patients with oropharyngeal cancer.

机构信息

Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.

出版信息

Laryngoscope. 2011 Apr;121(4):738-45. doi: 10.1002/lary.21457. Epub 2011 Mar 10.

DOI:10.1002/lary.21457

PMID:21394725

Abstract

OBJECTIVE

Positive volume-outcome relationships exist for diseases treated with technically complex surgery. Contemporary patterns of oropharyngeal cancer surgery by hospital and surgeon volume are poorly defined.

METHODS

The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon oropharyngeal cancer surgical case volumes from 1990 to 2009.

RESULTS

Overall, 1,534 oropharyngeal cancer surgeries were performed by 238 surgeons at 41 hospitals. Cases performed by high-volume surgeons increased from 18.9% in 1990 to 1999 to 24.8% in 2000 to 2009 (odds ratio [OR] = 1.5, P = .002), whereas cases performed at high-volume hospitals increased from 35.0% to 41.8% (OR = 1.7, P <.001). High-volume surgeons were significantly associated with university hospitals (OR = 25.9, P < .001) and were more likely to perform partial glossectomy (OR = 1.8, P = .002), total glossectomy (OR = 3.8, P < .001), and neck dissection (OR = 2.3, P < .001). High-volume hospitals were significantly associated with tonsillectomy (OR = 3.0, P < .001), partial glossectomy (OR = 1.4, P = .044), total glossectomy (OR = 4.3, P < .001), neck dissection (OR = 3.1, P < .001), flap reconstruction (OR = 1.9, P = .028), and prior radiation (OR = 5.0, P < .001). After controlling for other variables, oropharyngeal cancer surgery in 2000 to 2009 was associated with increased utilization of university hospitals (OR = 1.7, P < .001), increased mortality risk scores (OR = 3.1, P = .022), prior radiation (OR = 4.9, P = .011), and a decrease in partial glossectomy (OR = 0.5, P < .001), total glossectomy (OR = 0.4, P = .004), pharyngectomy (OR = 0.6, P = .007), and mandibulectomy (OR = 0.6, P = .022) procedures.

CONCLUSIONS

The proportion of oropharyngeal cancer surgery patients treated by high-volume surgeons and hospitals increased significantly from 1990 to 1999 to 2000 to 2009, with a decrease in partial glossectomy, total glossectomy, pharyngectomy, and mandibulectomy procedures. These findings may be due to changing trends in the primary management of oropharyngeal cancer.

摘要

目的

对于采用技术复杂手术治疗的疾病，存在阳性的手术量-结局关系。目前，医院和外科医生的口咽癌手术量的模式还没有明确的定义。

方法

从 1990 年到 2009 年，马里兰州卫生服务成本审查委员会数据库对口咽癌手术的医院和外科医生手术量进行了查询。

结果

共有 238 名外科医生在 41 家医院进行了 1534 例口咽癌手术。高手术量外科医生的手术比例从 1990 年至 1999 年的 18.9%增加到 2000 年至 2009 年的 24.8%（比值比[OR]为 1.5，P =.002），而高手术量医院的手术比例从 35.0%增加到 41.8%（OR = 1.7，P <.001）。高手术量外科医生与大学医院显著相关（OR = 25.9，P <.001），更有可能进行部分舌切除术（OR = 1.8，P =.002）、全舌切除术（OR = 3.8，P <.001）和颈部清扫术（OR = 2.3，P <.001）。高手术量医院与扁桃体切除术（OR = 3.0，P <.001）、部分舌切除术（OR = 1.4，P =.044）、全舌切除术（OR = 4.3，P <.001）、颈部清扫术（OR = 3.1，P <.001）、皮瓣重建术（OR = 1.9，P =.028）和既往放疗（OR = 5.0，P <.001）显著相关。在控制其他变量后，2000 年至 2009 年的口咽癌手术与大学医院的使用增加（OR = 1.7，P <.001）、死亡率评分增加（OR = 3.1，P =.022）、既往放疗（OR = 4.9，P =.011）以及部分舌切除术（OR = 0.5，P <.001）、全舌切除术（OR = 0.4，P =.004）、咽切除术（OR = 0.6，P =.007）和下颌骨切除术（OR = 0.6，P =.022）的减少相关。