治疗方式与肝内胆管细胞癌患者切缘状态和总体生存的相关性。
Facility Type is Associated with Margin Status and Overall Survival of Patients with Resected Intrahepatic Cholangiocarcinoma.
机构信息
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Newton Wellesley Hospital, Newton, MA, USA.
出版信息
Ann Surg Oncol. 2019 Nov;26(12):4091-4099. doi: 10.1245/s10434-019-07657-5. Epub 2019 Jul 31.
BACKGROUND
Many studies have demonstrated associations between surgical resections at academic centers and improved outcomes, particularly for complex operations. However, few studies have examined this relationship in intrahepatic cholangiocarcinoma (ICC). The hypothesis of this study was that facility type is associated with improved postoperative outcomes and survival for patients with ICC who undergo resection.
METHODS
Patients with stages 1 to 3 ICC who underwent hepatectomy were identified using the National Cancer Database (NCDB) (2004-2014). Facilities were categorized as academic or community centers per Commission on Cancer designations. High-volume hospitals were those that performed 11 or more hepatectomies per year. Multilevel logistic mixed-effects models to identify predictors of outcomes and parametric survival-time models were used to determine overall survival (OS).
RESULTS
The study identified 2256 patients. Of these patients, 423 (18.8%) were treated at community centers, and 1833 (81.3%) were treated at academic centers. Nearly all high-volume centers were academic facilities (98.5% academic vs. 1.5% community centers), whereas low-volume centers were mixed (65.5% academic vs. 34.5% community centers) (p < 0.001). Surgery performed at an academic center was an independent predictor of decreased positive margins (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.51-0.98; p = 0.04), a lower 90-day mortality rate (OR, 0.62; 95% CI, 0.39-0.97; p = 0.03), and improved OS (hazard ratio [HR], 0.78; 95% CI, 0.63-0.96; p = 0.02). Facility hepatectomy volume was not independently associated with any short- or long-term outcomes.
CONCLUSIONS
Treatment at an academic center is associated with fewer positive resection margins, a decreased 90-day mortality rate, and improved OS for patients who undergo ICC resection. Facility surgical volume was not shown to be significantly associated with any postoperative outcomes after adjustment for patient and disease characteristics.
背景
许多研究表明，在学术中心进行手术切除与改善结果之间存在关联，尤其是对于复杂手术。然而，很少有研究在肝内胆管癌 (ICC) 中检查这种关系。本研究的假设是，对于接受肝切除术的 ICC 患者，机构类型与术后结果和生存改善有关。
方法
使用国家癌症数据库 (NCDB)（2004-2014 年）确定 I 期至 III 期 ICC 患者。根据癌症委员会的指定，将机构分为学术或社区中心。高容量医院是指每年进行 11 次或更多次肝切除术的医院。使用多水平逻辑混合效应模型来识别结果的预测因素，并使用参数生存时间模型来确定总体生存率 (OS)。
结果
本研究共纳入 2256 名患者。其中，423 名（18.8%）在社区中心治疗，1833 名（81.3%）在学术中心治疗。几乎所有高容量中心都是学术机构（98.5%为学术机构，1.5%为社区中心），而低容量中心则混合存在（65.5%为学术机构，34.5%为社区中心）（p<0.001）。在学术中心进行手术是降低阳性切缘（优势比 [OR]，0.71；95%置信区间 [CI]，0.51-0.98；p=0.04）、降低 90 天死亡率（OR，0.62；95%CI，0.39-0.97；p=0.03）和改善 OS（风险比 [HR]，0.78；95%CI，0.63-0.96；p=0.02）的独立预测因素。机构肝切除术量与任何短期或长期结果均无独立关联。
结论
在学术中心治疗与 ICC 切除患者的更少阳性切缘、降低 90 天死亡率和改善 OS 相关。在调整患者和疾病特征后，机构手术量与任何术后结果均无显著关联。
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