Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Ann Surg Oncol. 2019 Jan;26(1):98-108. doi: 10.1245/s10434-018-6708-y. Epub 2018 Aug 25.
Surgical resection is the most important therapeutic intervention for eligible patients with pancreatic cancer; however, a majority of patients never receive surgery for a variety of reasons, including patient refusal. Utilizing the National Cancer Database, we investigated the associated sociodemographic and clinical factors for those patients who refused surgery, and the impact of this decision on overall survival (OS).
We analyzed adult patients with non-metastatic adenocarcinoma of the pancreas diagnosed from 2004 to 2013. Univariate and multivariate logistic regression modeling was used to identify factors predictive of refusing surgery, and Kaplan-Meier and log-rank analysis was performed to investigate the effect on OS.
A total of 48,902 patients were identified: 47,107 received surgery (96.3%) and 1795 were offered surgery but refused (3.7%). Factors associated with refusing surgery include both sociodemographic factors [age > 50 years, female sex, Black race, non-private insurance, treatment at a non-academic institution or non-metro facility, Carlson Comorbidity Index of 2 + (p ≤ 0.01)], and clinical factors [advanced clinical T (tumor) category and tumor size > 20 cm (p ≤ 0.01)]. Patients who refused surgery and received no treatment at all experienced a median survival of 5.1 months, while those who refused surgery but received chemoradiotherapy experienced a median survival of 11.2 months. As an index for comparison, those who received surgery had a median survival of 20.5 months.
Refusing surgery is an understudied phenomenon associated with several sociodemographic and clinical factors. The expected prognosis for patients who refuse surgery is presented.
手术切除是符合条件的胰腺癌患者最重要的治疗干预措施；然而，由于多种原因，包括患者拒绝手术，大多数患者从未接受过手术。利用国家癌症数据库，我们研究了那些拒绝手术的患者的相关社会人口统计学和临床因素，以及这一决定对总生存（OS）的影响。
我们分析了 2004 年至 2013 年间诊断为非转移性胰腺腺癌的成年患者。采用单变量和多变量逻辑回归模型来确定拒绝手术的预测因素，并进行 Kaplan-Meier 和对数秩分析以调查对 OS 的影响。
共确定了 48902 名患者：47107 名患者接受了手术（96.3%），1795 名患者接受了手术但拒绝了（3.7%）。拒绝手术的相关因素包括社会人口统计学因素（年龄>50 岁、女性、黑人、非私人保险、在非学术机构或非大都市地区接受治疗、卡森合并症指数为 2+（p≤0.01））和临床因素（晚期临床 T（肿瘤）分期和肿瘤大小>20cm（p≤0.01））。拒绝手术且未接受任何治疗的患者中位生存期为 5.1 个月，而拒绝手术但接受放化疗的患者中位生存期为 11.2 个月。作为比较指标，接受手术的患者中位生存期为 20.5 个月。
拒绝手术是一种被低估的现象，与多种社会人口统计学和临床因素有关。本文介绍了拒绝手术患者的预期预后。
