Sinno A K, Li X, Thompson R E, Tanner E J, Levinson K L, Stone R L, Temkin S M, Fader A N, Chi D S, Long Roche K
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Gynecol Oncol. 2017 Jun;145(3):493-499. doi: 10.1016/j.ygyno.2017.03.020. Epub 2017 Mar 30.
To describe the US national trends and factors associated with cytoreductive surgical radicality in women with advanced ovarian cancer (OC).
An analysis of the National Inpatient Sample database was performed. All admissions from 1993 to 2011 for advanced OC cytoreductive surgery (CRS) were identified and categorized as simple pelvic (SP), extensive pelvic (EP), and extensive upper abdominal (EUA) surgery. Annual trends in CRS were analyzed. Associations between patient- and hospital-specific factors, with CRS radicality as well as perioperative complications were explored between 2007 and 2011.
In total, 28,677 un-weighted admissions were analyzed. The rate of EP and EUA resections increased over time (8% to 18.1% and 1.3% to 5.4%, P<0.01, respectively). On multivariate analysis, patients were more likely to undergo EUA resections in the Northeast (OR 1.44) or West Coast (OR 1.47) at urban (OR 2.3), or large hospitals (OR 1.4), or if they had private insurance (OR 1.45). EUA surgeries were performed more frequently at high-volume ovarian cancer centers (OR 2.65); additionally, fewer complications were observed after EUA at high compared with low and medium volume hospitals (10.2%, 21.2%, and 21.7%, respectively; P=0.01). Specifically, patients treated at high volume hospitals experienced lower rates of hemorrhage, vascular/nerve injury, prolonged hospitalization, and non-routine discharge than at lower (P<0.05).
The US rate of radical cytoreductive surgery for advanced ovarian cancer is increasing. At high-volume hospitals, patients receive more radical surgery with fewer complications, supporting further study of a centralized ovarian cancer care model.
描述美国晚期卵巢癌（OC）女性患者减瘤手术彻底性的全国趋势及相关因素。
对国家住院样本数据库进行分析。确定1993年至2011年期间所有因晚期OC减瘤手术（CRS）的住院病例，并分类为简单盆腔手术（SP）、广泛盆腔手术（EP）和广泛上腹部手术（EUA）。分析CRS的年度趋势。探讨2007年至2011年期间患者和医院特定因素与CRS彻底性以及围手术期并发症之间的关联。
共分析了28,677例未加权的住院病例。EP和EUA切除术的比例随时间增加（分别从8%增至18.1%和1.3%增至5.4%，P<0.01）。多因素分析显示，患者在东北部（OR 1.44）或西海岸（OR 1.47）、城市医院（OR 2.3）或大型医院（OR 1.4），或有私人保险（OR 1.45）时更有可能接受EUA切除术。EUA手术在高容量卵巢癌中心更频繁进行（OR 2.65）；此外，与低容量和中等容量医院相比，高容量医院EUA术后并发症更少（分别为10.2%、21.2%和21.7%；P=0.01）。具体而言，高容量医院治疗的患者出血、血管/神经损伤、住院时间延长和非常规出院的发生率低于低容量医院（P<0.05）。
美国晚期卵巢癌的根治性减瘤手术率正在上升。在高容量医院，患者接受更彻底的手术且并发症更少，支持进一步研究集中式卵巢癌护理模式。
