低容量医院的治疗与腹膜后肉瘤患者的短期和长期预后降低有关。
Treatment at low-volume hospitals is associated with reduced short-term and long-term outcomes for patients with retroperitoneal sarcoma.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2018 Dec 1;124(23):4495-4503. doi: 10.1002/cncr.31699. Epub 2018 Oct 14.
BACKGROUND
Retroperitoneal sarcomas (RPS) are rare tumors for which complete surgical resection remains the mainstay of treatment. The objective of the current study was to determine the impact of hospital case volume on outcomes in patients with RPS.
METHODS
A total of 6950 patients with primary RPS who underwent surgical resection were identified from the National Cancer Data Base (1998-2011). Treating hospitals were classified by annual case volume; low-volume hospitals (LVHs) and high-volume hospitals (HVHs) were defined as those with ≤10 cases per year and >10 cases per year, respectively. Overall survival (OS) was compared using Kaplan-Meier curves. Cox proportional hazard models were created to compare risks.
RESULTS
Of the 1131 reporting hospitals, the majority (1127 hospitals; 99.6%) were LVHs treating the majority of patients (6270 patients; 90.2%). Patients treated at LVHs were more likely to have lower grade and smaller tumors, receive radiotherapy, and undergo incomplete macroscopic (R2) resection. Patients treated at HVHs had lower 30-day readmission rates (1.8% vs 3.4%; P<.001), 30-day (1.9% vs 3.1%; P=.004) and 90-day (3.2% vs 5.7%; P=.007) mortality, longer median OS (76.2 months vs 64.2 months; P<.001), and higher 5-year OS rates (58% vs 52%; P<.001). After controlling for age, sex, insurance status, tumor size, tumor grade, surgical resection margin status, and radiotherapy administration, treatment at an HVH was found to be independently associated with a reduced risk of death (hazard ratio, 0.77; 95% confidence interval, 0.65-0.91 [P=.003]).
CONCLUSIONS
Primary RPS are rare tumors, and to our knowledge few surgeons and institutions have significant experience and expertise in their multidisciplinary management and surgical resection. Although additional studies are needed, patient outcomes may be impacted by the case volume and expertise of the treating facility.
背景
腹膜后肉瘤（RPS）是一种罕见的肿瘤，完整的手术切除仍然是主要的治疗方法。本研究的目的是确定医院病例量对 RPS 患者治疗结果的影响。
方法
从国家癌症数据库（1998-2011 年）中确定了 6950 例接受手术切除的原发性 RPS 患者。根据每年的病例量对治疗医院进行分类；低容量医院（LVH）和高容量医院（HVH）定义为每年病例数≤10 例和>10 例的医院。使用 Kaplan-Meier 曲线比较总生存率（OS）。采用 Cox 比例风险模型比较风险。
结果
在 1131 家报告医院中，绝大多数（1127 家医院；99.6%）为 LVH，治疗了大多数患者（6270 例；90.2%）。在 LVH 治疗的患者中，肿瘤分级和体积较低、接受放疗和不完全的宏观（R2）切除的可能性更高。在 HVH 治疗的患者中，30 天再入院率较低（1.8%比 3.4%；P<.001），30 天（1.9%比 3.1%；P=.004）和 90 天（3.2%比 5.7%；P=.007）死亡率、较长的中位 OS（76.2 个月比 64.2 个月；P<.001）和较高的 5 年 OS 率（58%比 52%；P<.001）。在控制年龄、性别、保险状况、肿瘤大小、肿瘤分级、手术切除边缘状态和放疗后，在 HVH 治疗与降低死亡风险相关（风险比，0.77；95%置信区间，0.65-0.91 [P=.003]）。
结论
原发性 RPS 是罕见的肿瘤，据我们所知，很少有外科医生和机构在其多学科管理和手术切除方面具有丰富的经验和专业知识。尽管还需要进一步的研究，但患者的治疗结果可能会受到治疗机构的病例量和专业水平的影响。
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