Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands.
Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands.
Eur J Surg Oncol. 2018 Apr;44(4):532-538. doi: 10.1016/j.ejso.2018.01.008. Epub 2018 Jan 12.
Dutch national guidelines on the diagnosis and treatment of gastric cancer recommend the use of perioperative chemotherapy in patients with resectable gastric cancer. However, adjuvant chemotherapy is often not administered. The aim of this study was to evaluate hospital variation on the probability to receive adjuvant chemotherapy and to identify associated factors with special attention to postoperative complications.
All patients who received neoadjuvant chemotherapy and underwent an elective surgical resection for stage IB-IVa (M0) gastric adenocarcinoma between 2011 and 2015 were identified from a national database (Dutch Upper GI Cancer Audit). A multivariable linear mixed model was used to evaluate case-mix adjusted hospital variation and to identify factors associated with adjuvant therapy.
Of all surgically treated gastric cancer patients who received neoadjuvant chemotherapy (n = 882), 68% received adjuvant chemo(radio)therapy. After adjusting for case-mix and random variation, a large hospital variation in the administration rates for adjuvant was observed (OR range 0.31-7.1). In multivariable analysis, weight loss, a poor health status and failure of neoadjuvant chemotherapy completion were strongly associated with an increased likelihood of adjuvant therapy omission. Patients with severe postoperative complications had a threefold increased likelihood of adjuvant therapy omission (OR 3.07 95% CI 2.04-4.65).
Despite national guidelines, considerable hospital variation was observed in the probability of receiving adjuvant chemo(radio)therapy. Postoperative complications were strongly associated with adjuvant chemo(radio)therapy omission, underlining the need to further reduce perioperative morbidity in gastric cancer surgery.
荷兰国家胃癌诊治指南推荐可切除胃癌患者采用围手术期化疗，但辅助化疗常未予实施。本研究旨在评估医院在接受辅助化疗概率上的差异，并确定相关因素，特别关注术后并发症。
从全国数据库（荷兰上消化道癌症审计）中确定了 2011 年至 2015 年间接受新辅助化疗并接受选择性手术切除 IB-IVa 期（M0）胃腺癌的所有患者。采用多变量线性混合模型评估病例组合调整后的医院差异，并确定与辅助治疗相关的因素。
所有接受新辅助化疗的手术治疗胃癌患者（n=882）中，68%接受了辅助化疗（放化疗）。在调整病例组合和随机变异后，观察到辅助治疗给药率存在较大的医院差异（OR 范围 0.31-7.1）。多变量分析显示，体重减轻、健康状况差和新辅助化疗完成失败与辅助治疗遗漏的可能性增加密切相关。严重术后并发症的患者接受辅助治疗遗漏的可能性增加了三倍（OR 3.07 95%CI 2.04-4.65）。
尽管有国家指南，但接受辅助化疗（放化疗）的概率仍存在较大的医院差异。术后并发症与辅助化疗遗漏密切相关，这突显了进一步降低胃癌手术围手术期发病率的必要性。
