Department of Surgery, University of Utah, Salt Lake City, UT.
Surgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT.
Ann Surg. 2020 Dec;272(6):1102-1109. doi: 10.1097/SLA.0000000000003236.
The aim of the study was to describe county-level variation in use of surgery for stage I-II pancreatic ductal adenocarcinoma (PDAC) and the association between county surgery rates and cancer-specific survival (CSS).
The degree of small geographic area variation in use of surgery for stage I-II PDAC and the association between area surgery rates and CSS remain incompletely defined.
This is a retrospective cohort study of patients aged 18 to 80 years in the 2007 to 2015 Surveillance, Epidemiology, and End Results database with stage I-II PDAC without contraindications to surgery or refusal. Multilevel models were used to characterize county-level variation in use of surgery and CSS. County-specific risk- and reliability-adjusted surgery rates and CSS rates were calculated.
Of 18,100 patients living in 581 counties, 10,944 (60.5%) underwent surgery. Adjusted county-specific surgery rates varied 1.5-fold from 49.9% to 74.6%. Median CSS increased in a graded fashion from 13 months [interquartile range (IQR) 13-14] in counties with surgery rates of 49.9% to 56.9% to 18 months (IQR 17-19) in counties with surgery rates of 68.0% to 74.6%. Results were similar in multivariable analyses. Adjusted county 18-month CSS rates varied 1.6-fold from 32.7% to 53.7%. Adjusted county surgery and 18-month CSS rates were correlated (r = 0.54; P < 0.001) and county surgery rates explained approximately half of county-level variation in CSS. Only 18 (3.1%) counties had adjusted surgery rates of 68.0% to 74.6%, which was associated with the longest CSS.
County-specific rates of surgery varied substantially, and patients living in areas with higher surgery rates lived longer. These data suggest that increasing use of surgery in stage I-II PDAC could lead to improvements in survival.
本研究旨在描述 I 期- II 期胰腺导管腺癌（PDAC）手术使用的县级差异以及县手术率与癌症特异性生存（CSS）之间的关联。
I 期- II 期 PDAC 手术使用的小地理区域差异程度以及区域手术率与 CSS 之间的关联仍未完全确定。
这是一项回顾性队列研究，纳入了 2007 年至 2015 年监测、流行病学和最终结果数据库中年龄在 18 至 80 岁之间、无手术禁忌证或拒绝手术的 I 期- II 期 PDAC 患者。使用多水平模型描述手术使用和 CSS 的县级差异。计算了县级特异性风险和可靠性调整后的手术率和 CSS 率。
在 581 个县的 18100 名患者中，有 10944 名（60.5%）接受了手术。调整后的县级特异性手术率从 49.9%到 74.6%不等，差异达 1.5 倍。CSS 中位数呈梯度增加，从手术率为 49.9%至 56.9%的县的 13 个月[四分位距（IQR）13-14]增加到手术率为 68.0%至 74.6%的县的 18 个月（IQR 17-19）。多变量分析结果相似。调整后的县 18 个月 CSS 率从 32.7%到 53.7%不等，差异达 1.6 倍。调整后的县手术和 18 个月 CSS 率呈正相关（r = 0.54；P < 0.001），县手术率解释了 CSS 县级差异的大约一半。只有 18 个（3.1%）县的调整手术率为 68.0%至 74.6%，这与最长的 CSS 相关。
县级特异性手术率差异很大，接受手术的患者生存时间更长。这些数据表明，在 I 期- II 期 PDAC 中增加手术的使用可能会提高生存率。
