基于人群的研究：结直肠癌肝转移患者术前全身化疗的实践差异及对短期结局的影响。
Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes.
机构信息
Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
出版信息
Eur J Surg Oncol. 2020 Sep;46(9):1742-1755. doi: 10.1016/j.ejso.2020.03.221. Epub 2020 Apr 5.
INTRODUCTION
Definitions regarding resectability and hence indications for preoperative chemotherapy vary. Use of preoperative chemotherapy may influence postoperative outcomes. This study aimed to assess the variation in use of preoperative chemotherapy for CRLM and related postoperative outcomes in the Netherlands.
MATERIALS AND METHODS
All patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were included from a national database. Case-mix factors contributing to the use of preoperative chemotherapy, hospital variation and postoperative outcomes were assessed using multivariable logistic regression. Postoperative outcomes were postoperative complicated course (PCC), 30-day morbidity and 30-day mortality.
RESULTS
In total, 4469 patients were included of whom 1314 patients received preoperative chemotherapy and 3155 patients did not. Patients receiving chemotherapy were significantly younger (mean age (+SD) 66.3 (10.4) versus 63.2 (10.2) p < 0.001) and had less comorbidity (Charlson scores 2+ (24% versus 29%, p = 0.010). Unadjusted hospital variation concerning administration of preoperative chemotherapy ranged between 2% and 55%. After adjusting for case-mix factors, three hospitals administered significantly more preoperative chemotherapy than expected and six administered significantly less preoperative chemotherapy than expected. PCC was 12.1%, 30-day morbidity was 8.8% and 30-day mortality was 1.5%. No association between preoperative chemotherapy and PCC (OR 1.24, 0.98-1.55, p = 0.065), 30-day morbidity (OR 1.05, 0.81-1.39, p = 0.703) or with 30-day mortality (OR 1.22, 0.75-2.09, p = 0.467) was found.
CONCLUSION
Significant hospital variation in the use of preoperative chemotherapy for CRLM was present in the Netherlands. No association between postoperative outcomes and use of preoperative chemotherapy was found.
简介
关于可切除性的定义，因此术前化疗的适应证有所不同。术前化疗的应用可能会影响术后结果。本研究旨在评估荷兰结直肠癌肝转移（CRLM）患者术前化疗的应用变化及其相关术后结果。
材料与方法
从国家数据库中纳入 2014 年至 2018 年间在荷兰接受肝切除术治疗 CRLM 的所有患者。使用多变量逻辑回归评估与术前化疗使用相关的病例组合因素、医院间差异和术后结果。术后结果为术后复杂病程（PCC）、30 天发病率和 30 天死亡率。
结果
共纳入 4469 例患者，其中 1314 例患者接受了术前化疗，3155 例患者未接受。接受化疗的患者明显更年轻（平均年龄（+标准差）66.3（10.4）比 63.2（10.2），p<0.001），合并症较少（Charlson 评分 2+（24%）比 29%，p=0.010）。未调整的术前化疗应用的医院间差异在 2%至 55%之间。调整病例组合因素后，有 3 家医院的术前化疗使用率明显高于预期，有 6 家医院的术前化疗使用率明显低于预期。PCC 为 12.1%，30 天发病率为 8.8%，30 天死亡率为 1.5%。术前化疗与 PCC（OR 1.24，0.98-1.55，p=0.065）、30 天发病率（OR 1.05，0.81-1.39，p=0.703）或 30 天死亡率（OR 1.22，0.75-2.09，p=0.467）之间无相关性。
结论
荷兰 CRLM 患者术前化疗的应用存在显著的医院间差异。未发现术后结果与术前化疗应用之间存在相关性。
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