Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611, USA.
Cancer. 2013 Apr 1;119(7):1412-9. doi: 10.1002/cncr.27891. Epub 2012 Nov 26.
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) generally has not collected cancer-specific variables. Because increasing numbers of studies are using ACS NSQIP data to study cancer surgery, the objectives of the current study were 1) to examine differences between existing ACS NSQIP variables and cancer registry variables, and 2) to determine whether the addition of cancer-specific variables improves modeling of short-term outcomes.
Data from patients in the ACS NSQIP and National Cancer Data Base (NCDB) who underwent colorectal resection for cancer were linked (2006-2008). By using regression methods, the relative importance of cancer staging and neoadjuvant therapy variables were assessed along with their effects on morbidity, serious morbidity, and mortality.
From 146 hospitals, 11,405 patients were identified who underwent surgery for colorectal cancer (colon, 85%; rectum, 15%). The NCDB metastatic cancer variable and the ACS NSQIP disseminated cancer variables agreed marginally (Cohen kappa coefficient, 0.454). For mortality, only the ACS NSQIP disseminated cancer variable and the NCDB stage IV variable were identified as important predictors; whereas the variables stage I through III, tumor (T)-classification, and lymph node (N)-classification were not selected. Cancer stage variables were inconsistently important for serious morbidity (stage IV, T-classification), superficial surgical site infection (N-classification), venous thromboembolism (metastatic cancer), and pneumonia (T-classification). With respect to neoadjuvant therapy, ACS NSQIP and NCDB variables agreed moderately (kappa, 0.570) and predicted superficial surgical site infection, serious morbidity, and organ space surgical site infection. The model fit was similar regardless of the inclusion of stage and neoadjuvant therapy variables.
Although advanced disease stage and neoadjuvant therapy variables were predictors of short-term outcomes, their inclusion did not improve the models.
美国外科医师学院（ACS）国家外科质量改进计划（NSQIP）通常未收集癌症特异性变量。由于越来越多的研究使用 ACS NSQIP 数据来研究癌症手术，本研究的目的是 1）检查现有 ACS NSQIP 变量与癌症登记变量之间的差异，2）确定是否添加癌症特异性变量可改善短期结果的建模。
将 ACS NSQIP 和国家癌症数据库（NCDB）中接受结直肠癌切除术的癌症患者的数据进行链接（2006-2008 年）。通过使用回归方法，评估癌症分期和新辅助治疗变量的相对重要性，以及它们对发病率、严重发病率和死亡率的影响。
从 146 家医院中，确定了 11405 例接受结直肠癌手术的患者（结肠癌 85%；直肠癌 15%）。NCDB 转移性癌症变量和 ACS NSQIP 弥散性癌症变量的一致性较差（Cohen kappa 系数为 0.454）。对于死亡率，只有 ACS NSQIP 弥散性癌症变量和 NCDB 第 IV 期变量被确定为重要的预测因子；而第 I 至 III 期、肿瘤（T）分类和淋巴结（N）分类变量则未被选中。癌症分期变量对严重发病率（第 IV 期、T 分类）、浅表手术部位感染（N 分类）、静脉血栓栓塞（转移性癌症）和肺炎（T 分类）的重要性不一致。关于新辅助治疗，ACS NSQIP 和 NCDB 变量一致性中等（kappa 值为 0.570），可预测浅表手术部位感染、严重发病率和器官间隙手术部位感染。无论是否包含分期和新辅助治疗变量，模型拟合情况相似。
尽管晚期疾病分期和新辅助治疗变量是短期结果的预测因子，但它们的纳入并未改善模型。
