Shannon Adrienne B, Mo Julia, Song Yun, Paulson Emily C, Roses Robert E, Fraker Douglas L, Kelz Rachel R, Miura John T, Karakousis Giorgos C
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Oncol. 2020 Sep;122(4):729-738. doi: 10.1002/jso.26075. Epub 2020 Jun 20.
Regionalization of oncologic care has increased, but less is known whether patient outcomes are influenced by receipt of multimodality care through multicenter care (MCC) or single-center care (SCC).
Patients from 2004 to 2015 National Cancer Data Base diagnosed with stage II-III esophageal (EA), stage II-III pancreatic (PA), and stage II-IV rectal (RA) adenocarcinoma who underwent resection at a high volume center (HVC) and required radiation and/or chemotherapy were included. MCC (care at 2+ facilities) and SCC patients were propensity-score matched 1:2 and Cox proportional hazards regression used to analyze survival.
On multivariable regression analysis, MCC in RA patients (N = 325/2097, 15.5%) was more associated with residing ≥40 miles from the HVC (odds ratio [OR] = 2.37; P = .044) and receipt of neoadjuvant chemotherapy (1.42, P = .040). In PA patients (N = 75/380, 19.7%), residing ≥40 miles from the HVC (OR = 3.22; P = .001), and in EA patients (N = 88/534, 16.5%), younger patients (<50 years: OR = 2.96; P = .011) were associated with MCC. Following propensity score matching, EA (N = 147), PA (N = 133), and RA (N = 661) patients had no difference in 1-year and 3-year overall survival when comparing MCC to SCC.
The use of MCC appears safe without a difference in survival and may offer significant advantages in convenience to patients as they undergo their complex oncologic care.
肿瘤护理的区域化有所增加，但对于多模式护理是通过多中心护理（MCC）还是单中心护理（SCC）提供，以及这是否会影响患者预后，人们了解较少。
纳入2004年至2015年国家癌症数据库中诊断为II - III期食管癌（EA）、II - III期胰腺癌（PA）和II - IV期直肠癌（RA）腺癌且在高容量中心（HVC）接受手术切除并需要放疗和/或化疗的患者。MCC（在2个及以上机构接受护理）和SCC患者按倾向得分1:2匹配，并使用Cox比例风险回归分析生存率。
在多变量回归分析中，RA患者（N = 325/2097，15.5%）接受MCC与居住在距离HVC≥40英里处（比值比[OR] = 2.37；P = 0.044）以及接受新辅助化疗（1.42，P = 0.040）的相关性更高。在PA患者（N = 75/380，19.7%）中，居住在距离HVC≥40英里处（OR = 3.22；P = 0.001），在EA患者（N = 88/534，16.5%）中，年轻患者（<50岁：OR = 2.96；P = 0.011）与接受MCC相关。倾向得分匹配后，比较MCC和SCC时，EA（N = 147）、PA（N = 133）和RA（N = 661）患者在1年和3年总生存率方面没有差异。
使用MCC似乎是安全的，生存率无差异，并且在患者接受复杂的肿瘤护理时，可能在便利性方面具有显著优势。
