Bagaria Sanjay P, Neville Matthew, Gray Richard J, Gabriel Emmanuel, Ashman Jonathan B, Attia Steven, Wasif Nabil
Department of Surgery, Section of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA.
Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA.
Sarcoma. 2018 Jul 24;2018:3056562. doi: 10.1155/2018/3056562. eCollection 2018.
We sought to study the association between RPS case volume and outcomes. Although a relationship has been demonstrated between case volume and patient outcomes in some cancers, such a relationship has not been established for retroperitoneal sarcomas (RPSs).
The National Cancer Database (NCDB) was queried for patients undergoing treatment for primary RPS diagnosed between 2004 and 2013. Mean annual patient volume for RPS resection was calculated for all hospitals and divided into low volume (<5 cases/year), medium volume (5-10 cases/year), and high volume (>10 cases/year). Risk-adjusted regression analyses were performed to identify predictors of 30-day surgical mortality, 0 margin status, and overall survival (OS).
Our study population consisted of 5,407 patients with a median age of 61 years, of whom 47% were male and 3,803 (70%) underwent surgical resection. Absolute 30-day surgical mortality and 0 margin rate following surgery for low-, medium-, and high-volume institutions were 2.4%, 1.3%, and 0.5% (=0.027) and 68%, 65%, and 82%, ( < 0.001), respectively. Five-year overall survival rates for low, medium, and high-volume institutions were 56%, 57%, and 66%, respectively ( < 0.001). Patients treated at low-volume institutions had a significantly higher risk of 30-day mortality (adjusted OR = 4.66, 95% CI 2.26-9.63) and long-term mortality (adjusted HR = 1.56, 95% CI 1.16-2.11) compared to high-volume institutions.
We demonstrate the existence of a hospital sarcoma service line volume-oncologic outcome relationship for RPS at the national level and provide benchmark data for cancer care delivery systems and policy makers.
我们试图研究腹膜后肉瘤（RPS）的病例数量与治疗结果之间的关联。虽然在某些癌症中已证实病例数量与患者治疗结果之间存在关联，但对于腹膜后肉瘤（RPS），这种关系尚未确立。
查询国家癌症数据库（NCDB）中2004年至2013年间接受原发性RPS治疗的患者。计算所有医院RPS切除的年均患者数量，并分为低病例量组（<5例/年）、中等病例量组（5 - 10例/年）和高病例量组（>10例/年）。进行风险调整回归分析，以确定30天手术死亡率、切缘阴性状态和总生存期（OS）的预测因素。
我们的研究人群包括5407例患者，中位年龄为61岁，其中47%为男性，3803例（70%）接受了手术切除。低、中、高病例量机构术后30天绝对手术死亡率和切缘阴性率分别为2.4%、1.3%和0.5%（P = 0.027）以及68%、65%和82%（P < 0.001）。低、中、高病例量机构的五年总生存率分别为56%、57%和66%（P < 0.001）。与高病例量机构相比，在低病例量机构接受治疗的患者30天死亡率（调整后OR = 4.66，95% CI 2.26 - 9.63）和长期死亡率（调整后HR = 1.56，95% CI 1.16 - 2.11）显著更高。
我们证实在国家层面上，医院肉瘤服务线的病例量与RPS的肿瘤学治疗结果之间存在关联，并为癌症护理提供系统和政策制定者提供了基准数据。
