胃癌切除术与医院手术量对复发和生存的影响：CRITICS 试验结果。

Effect of Hospital Volume With Respect to Performing Gastric Cancer Resection on Recurrence and Survival: Results From the CRITICS Trial.

机构信息

Department of Surgical Oncology, Leiden University Medical Center, The Netherlands.

Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

出版信息

Ann Surg. 2019 Dec;270(6):1096-1102. doi: 10.1097/SLA.0000000000002940.

DOI:10.1097/SLA.0000000000002940

PMID:29995679

Abstract

OBJECTIVE

We examined the association between surgical hospital volume and both overall survival (OS) and disease-free survival (DFS) using data obtained from the international CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial.

SUMMARY BACKGROUND DATA

In the CRITICS trial, patients with resectable gastric cancer were randomized to receive preoperative chemotherapy followed by adequate gastrectomy and either chemotherapy or chemoradiotherapy.

METHODS

Patients in the CRITICS trial who underwent a gastrectomy with curative intent in a Dutch hospital were included in the analysis. The annual number of gastric cancer surgeries performed at the participating hospitals was obtained from the Netherlands Cancer Registry; the hospitals were then classified as low-volume (1-20 surgeries/year) or high-volume (≥21 surgeries/year) and matched with the CRITICS trial data. Univariate and multivariate analyses were then performed to evaluate the hazard ratio (HR) between hospital volume and both OS and DFS.

RESULTS

From 2007 through 2015, 788 patients were included in the CRITICS trial. Among these 788 patients, 494 were eligible for our study; the median follow-up was 5.0 years. Five-year OS was 59.2% and 46.1% in the high-volume and low-volume hospitals, respectively. Multivariate analysis revealed that undergoing surgery in a high-volume hospital was associated with higher OS [HR = 0.69, 95% confidence interval (CI) = 0.50-0.94, P = 0.020] and DFS (HR = 0.73, 95% CI: 0.54-0.99, P = 0.040).

CONCLUSIONS

In the CRITICS trial, hospitals with a high annual volume of gastric cancer surgery were associated with higher overall and DFS. These findings emphasize the value of centralizing gastric cancer surgeries in the Western world.

摘要

目的

我们利用国际 CRITICS（胃癌诱导化疗后的放化疗）试验获得的数据，研究手术医院的容量与总生存率（OS）和无病生存率（DFS）之间的关系。

背景资料概要

在 CRITICS 试验中，可切除的胃癌患者被随机分为接受术前化疗，然后进行充分的胃切除术，以及接受化疗或放化疗。

方法

在荷兰医院接受根治性胃切除术的 CRITICS 试验患者被纳入分析。从荷兰癌症登记处获得参加医院每年进行的胃癌手术数量；然后将这些医院分为低容量（每年 1-20 例手术）或高容量（≥21 例手术），并与 CRITICS 试验数据相匹配。然后进行单变量和多变量分析，以评估医院容量与 OS 和 DFS 之间的危险比（HR）。

结果

2007 年至 2015 年，788 例患者纳入 CRITICS 试验。在这 788 例患者中，有 494 例符合我们的研究标准；中位随访时间为 5.0 年。高容量和低容量医院的 5 年 OS 分别为 59.2%和 46.1%。多变量分析显示，在高容量医院接受手术与更高的 OS 相关 [HR=0.69，95%置信区间（CI）=0.50-0.94，P=0.020]和 DFS（HR=0.73，95%CI：0.54-0.99，P=0.040）。