Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
Ann Surg Oncol. 2021 Aug;28(8):4484-4496. doi: 10.1245/s10434-020-09510-6. Epub 2021 Jan 23.
This study aimed to describe the incidence of failure to cure (a composite outcome measure defined as surgery not meeting its initial aim), and the impact of hospital variation in the administration of neoadjuvant therapy on this outcome measure.
All patients in the Dutch Upper Gastrointestinal Cancer Audit undergoing curatively intended gastric cancer surgery in 2011-2019 were included. Failure to cure was defined as (1) 'open-close' surgery; (2) irradical surgery (R1/R2); or (3) 30-day/in-hospital mortality. Case-mix-corrected funnel plots, based on multivariable logistic regression analyses, investigated hospital variation. The impact of a hospital's tendency to administer neoadjuvant chemotherapy on the heterogeneity in failure to cure between hospitals was assessed based on median odds ratios and multilevel logistic regression analyses.
Some 3862 patients from 28 hospitals were included. Failure to cure was noted in 22.3% (hospital variation: 14.5-34.8%). After case-mix correction, two hospitals had significantly higher-than-expected failure to cure rates, and one hospital had a lower-than-expected rate. The failure to cure rate was significantly higher in hospitals with a low tendency to administer neoadjuvant chemotherapy. Approximately 29% of hospital variation in failure to cure could be attributed to different hospital policies regarding neoadjuvant therapy.
Failure to cure has an incidence of 22% in patients undergoing gastric cancer surgery. Higher failure to cure rates were seen in centers administering less neoadjuvant chemotherapy, which confirms the Dutch guideline recommendation on the administration of neoadjuvant chemotherapy. Failure to cure provides short loop feedback and can be used as a quality indicator in surgical audits.
本研究旨在描述治疗失败的发生率（定义为手术未达到其初始目标的复合结局指标），以及新辅助治疗管理方面医院间差异对该结局指标的影响。
纳入 2011 年至 2019 年间荷兰上消化道癌症审核中接受根治性胃癌手术的所有患者。治疗失败定义为：（1）“开-关”手术；（2）非根治性手术（R1/R2）；或（3）30 天/住院内死亡率。基于多变量逻辑回归分析的校正病例混合漏斗图，研究了医院间的差异。基于中位数优势比和多水平逻辑回归分析，评估了医院应用新辅助化疗的倾向对医院间治疗失败异质性的影响。
来自 28 家医院的 3862 例患者纳入研究。治疗失败率为 22.3%（医院间差异：14.5%-34.8%）。校正病例混合后，两所医院的治疗失败率显著高于预期，一所医院的治疗失败率显著低于预期。新辅助化疗应用倾向较低的医院治疗失败率显著更高。治疗失败的约 29%的医院间差异可归因于新辅助治疗的不同医院政策。
接受胃癌手术的患者治疗失败发生率为 22%。接受新辅助化疗较少的中心治疗失败率更高，这证实了荷兰关于新辅助化疗应用的指南建议。治疗失败提供了短期反馈回路，可以作为手术审核的质量指标。
