晚期结肠癌原发灶切除手术方式的差异：一项基于国家癌症数据库的研究
Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base.
作者信息
Healy Mark A, Pradarelli Jason C, Krell Robert W, Regenbogen Scott E, Suwanabol Pasithorn A
机构信息
Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
出版信息
Am J Surg. 2016 Oct;212(4):579-586. doi: 10.1016/j.amjsurg.2016.06.003. Epub 2016 Jul 18.
BACKGROUND
Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use.
METHODS
We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals). We first identified patient characteristics associated with primary tumor resection. Then, we assessed nationwide variation in hospital resection rates.
RESULTS
Overall, 27,387 (53.9%) patients underwent primary site resection. Factors associated with resection included younger age, having less than 2 major comorbidities, and white race (P < .001). Nationwide, hospital-adjusted primary tumor resection rates ranged from 26.0% to 87.8% with broad differences across geographical areas and hospital accreditation types.
CONCLUSIONS
There is statistically significant variation in hospital rates of primary site resection. This demonstrates inconsistent adherence to guidelines in the presence of conflicting evidence regarding resection benefit.
背景
转移性结肠癌的治疗可能更多地受实践模式而非疾病特征的驱动。为了优化管理，有必要更好地了解决定原发部位切除使用情况的因素。
方法
我们评估了2002年至2012年国家癌症数据库中所有IV期癌症患者（50791例患者，1230家医院）。我们首先确定与原发肿瘤切除相关的患者特征。然后，我们评估了全国范围内医院切除率的差异。
结果
总体而言，27387例（53.9%）患者接受了原发部位切除。与切除相关的因素包括年龄较小、合并症少于2种以及白种人（P <.001）。在全国范围内，经医院调整后的原发肿瘤切除率在26.0%至87.8%之间，不同地理区域和医院认证类型存在广泛差异。
结论
医院原发部位切除率存在统计学上的显著差异。这表明在存在关于切除益处的相互矛盾证据的情况下，对指南的遵循不一致。
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