Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA.
School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
J Gastrointest Surg. 2020 May;24(5):1071-1076. doi: 10.1007/s11605-019-04389-5. Epub 2020 Feb 24.
Current treatment guidelines for gallbladder cancer range from simple cholecystectomy to regional hepatic resection. Treatment patterns for radical resection and adjuvant chemotherapy vary. We aim to determine if there is any disparity in treatment or difference in survival between academic versus community treatment centers.
The National Cancer Database (NCDB) was queried from 2004 to 2014 for gallbladder carcinoma. Cases were stratified into treatment sites as "Community Cancer Center" (CCC) or "Academic Cancer Center" (ACC). Propensity score matching was performed for patient demographics, TNM stage, resection type, and administration of adjuvant chemotherapy. The primary outcome included 30-day mortality, 90-day mortality, and overall survival.
There are similar frequencies of radical versus simple resection and administration of adjuvant chemotherapy between ACC and CCC. When propensity-matched for resection type, cases treated at ACC have lower 30-day mortality (4.1% vs. 6.9%) and 90-day mortality (13.2% vs. 18.5%) and increased 5-year overall survival (26.2% vs. 22.4%) (p < 0.01). After propensity matching for adjuvant chemotherapy, cases at ACC have lower 30-day mortality (4.12% vs. 7.71%) and 90-day mortality (13.22% vs. 19.19%) and increased overall survival (13.6% vs. 11.0%) (p < 0.01).
While treatment patterns for gallbladder cancer at ACC and CCC were similar, there was a decrease in 30-day and 90-day mortality and improved overall survival associated with patients treated at ACC. Treatment site may have an impact in the surgical outcomes of gallbladder cancer patients. This disparity warrants further research.
目前胆囊癌的治疗指南包括单纯胆囊切除术和局部肝切除术。根治性切除术和辅助化疗的治疗模式存在差异。我们旨在确定在学术治疗中心和社区治疗中心之间是否存在治疗差异或生存差异。
从 2004 年到 2014 年，国家癌症数据库（NCDB）被查询用于胆囊癌。病例分为治疗地点为“社区癌症中心”（CCC）或“学术癌症中心”（ACC）。对患者人口统计学、TNM 分期、切除术类型和辅助化疗的使用进行倾向评分匹配。主要结局包括 30 天死亡率、90 天死亡率和总生存率。
ACC 和 CCC 之间根治性切除术与单纯切除术以及辅助化疗的频率相似。当按切除术类型进行倾向评分匹配时，ACC 治疗的病例 30 天死亡率（4.1%比 6.9%）和 90 天死亡率（13.2%比 18.5%）较低，5 年总生存率（26.2%比 22.4%）较高（p<0.01）。在倾向评分匹配辅助化疗后，ACC 治疗的病例 30 天死亡率（4.12%比 7.71%）和 90 天死亡率（13.22%比 19.19%）较低，总生存率（13.6%比 11.0%）较高（p<0.01）。
虽然 ACC 和 CCC 的胆囊癌治疗模式相似，但 ACC 治疗的患者 30 天和 90 天死亡率降低，总生存率提高。治疗地点可能会影响胆囊癌患者的手术结果。这种差异值得进一步研究。
