胰腺腺癌胰十二指肠切除术后医院类型对生存结局的影响。
Influence of facility type on survival outcomes after pancreatectomy for pancreatic adenocarcinoma.
作者信息
Chu Quyen D, Zhou Meijiao, Peddi Prakash, Medeiros Kaelen L, Zibari Gazi B, Shokouh-Amiri Hosein, Wu Xiao-Cheng
机构信息
Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA; The Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA.
Louisiana Tumor Registry & Epidemiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA; School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
出版信息
HPB (Oxford). 2017 Dec;19(12):1046-1057. doi: 10.1016/j.hpb.2017.04.017. Epub 2017 Sep 28.
INTRODUCTION
Although a volume-outcome relationship has been well established for pancreatectomy, little is known about differences in mortality by facility type. The objective of this study is to evaluate the impact of facility type on short-term and long-term survival outcomes for patients with pancreatic adenocarcinoma who underwent pancreatectomy and identify determinants of overall survival (OS).
METHODS
A cohort of 33,382 patients with Stage I-III pancreatic adenocarcinoma diagnosed between 1998 and 2011 were evaluated from the National Cancer Data Base. Clinicopathological, sociodemographic and treatment variables were compared among three facility types where patients received resection: (i) community cancer program (CCP), (ii) comprehensive community cancer program (CCCP), and (iii) academic research program (ARP). 5-year OS was calculated using the Kaplan-Meier method.
RESULTS
Despite ARP having significantly higher percentage of poorly differentiated tumors, higher T-stage tumors, more positive lymph nodes, and greater circle distance compared to the other facilities, it had the highest 5-yr OS. The 5-yr OS for CCP, CCCP, and ARP was 11.2%, 13.2%, and 16.6%, respectively (P < 0.0001) and the median survival time (months) was 12.4, 15.6 and 19.1, respectively.
CONCLUSION
Patients receiving pancreatic resection at an ARP yielded a higher 5-year OS compared to CCP or CCCP.
引言
尽管胰腺切除术中的手术量与预后的关系已得到充分证实，但对于不同类型医疗机构的死亡率差异却知之甚少。本研究的目的是评估医疗机构类型对接受胰腺切除术的胰腺腺癌患者短期和长期生存结果的影响，并确定总生存期（OS）的决定因素。
方法
从国家癌症数据库中评估了1998年至2011年间诊断为I-III期胰腺腺癌的33382例患者队列。比较了患者接受手术切除的三种医疗机构类型之间的临床病理、社会人口统计学和治疗变量：（i）社区癌症项目（CCP），（ii）综合社区癌症项目（CCCP），以及（iii）学术研究项目（ARP）。使用Kaplan-Meier方法计算5年总生存期。
结果
尽管与其他医疗机构相比，ARP中低分化肿瘤、高T分期肿瘤、阳性淋巴结更多且切缘距离更大的比例显著更高，但其5年总生存期最高。CCP、CCCP和ARP的5年总生存期分别为11.2%、13.2%和16.6%（P < 0.0001），中位生存时间（月）分别为12.4、15.6和19.1。
结论
与CCP或CCCP相比，在ARP接受胰腺切除术的患者5年总生存期更高。
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