直肠癌患者中阳性环周切缘的医院和外科医生差异。
Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients.
机构信息
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
New York State Cancer Registry, New York State Department of Health, Albany, NY, USA.
出版信息
Am J Surg. 2019 Nov;218(5):881-886. doi: 10.1016/j.amjsurg.2019.02.029. Epub 2019 Feb 28.
BACKGROUND
The objective of this study was to evaluate variation in positive CRM at the surgeon and hospital levels and assess impact on disease-specific survival.
METHODS
Patients with stage I-III rectal cancer were identified in New York State. Bayesian hierarchical regressions estimated observed-to-expected (O/E) ratios for each surgeon/hospital. Competing-risks analyses estimated disease-specific survival among patients who were treated by surgeons/hospitals with O/E > 1 compared to those with O/E ratio ≤ 1.
RESULTS
Among 1,251 patients, 208 (17%) had a positive CRM. Of the 345 surgeons and 118 hospitals in the study, 99 (29%) and 48 (40%) treated a higher number of patients with CRM than expected, respectively. Patients treated by surgeons with O/E > 1 (HR = 1.38, 95% CI = 1.16, 1.67) and those treated at hospitals with O/E > 1 (HR = 1.44, 95% CI = 1.11, 1.85) had worse disease-specific survival.
DISCUSSION
Surgeon and hospital performance in positive CRM is associated with worse prognosis suggesting opportunities to enhance referral patterns and standardize care.
背景
本研究旨在评估外科医生和医院层面的阳性 CRM 差异，并评估其对疾病特异性生存的影响。
方法
在纽约州确定了 I-III 期直肠癌患者。贝叶斯层次回归估计了每位外科医生/医院的观察到的与预期的（O/E）比值。竞争风险分析估计了 O/E > 1 的外科医生/医院治疗的患者与 O/E 比值≤1 的患者之间的疾病特异性生存率。
结果
在 1251 名患者中，有 208 名（17%）有阳性 CRM。在研究中的 345 名外科医生和 118 家医院中，分别有 99 名（29%）和 48 名（40%）治疗的 CRM 患者数量超过预期。O/E > 1 的外科医生治疗的患者（HR = 1.38，95%CI = 1.16，1.67）和 O/E > 1 的医院治疗的患者（HR = 1.44，95%CI = 1.11，1.85）疾病特异性生存率更差。
讨论
阳性 CRM 中外科医生和医院的表现与预后较差相关，表明有机会改善转诊模式并标准化治疗。
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