Hoehn Richard S, Rieser Caroline J, Winters Sharon, Stitt Lauren, Hogg Melissa E, Bartlett David L, Lee Kenneth K, Paniccia Alessandro, Ohr James P, Gorantla Vikram C, Krishnamurthy Anuradha, Rhee John C, Bahary Nathan, Olson Adam C, Burton Steve, Ellsworth Susannah G, Slivka Adam, McGrath Kevin, Khalid Asif, Fasanella Kenneth, Chennat Jennifer, Brand Randal E, Das Rohit, Sarkaria Ritu, Singhi Aatur D, Zeh Herbert J, Zureikat Amer H
Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Cancer Registries, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Ann Surg Oncol. 2021 May;28(5):2438-2446. doi: 10.1245/s10434-021-09594-8. Epub 2021 Feb 1.
National studies have demonstrated disparities in the treatment and survival of pancreatic cancer patients based on socioeconomic status (SES). This study aimed to identify specific differences in perioperative management and outcomes based on patient SES and to study the role of a multidisciplinary clinic (MDC) in mitigating any variations.
The study analyzed patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma in a large hospital system. The patients were categorized into groups of high and low SES and whether they were managed by the authors' pancreatic cancer MDC or not. The study compared differences in disease characteristics, receipt of multimodality therapy, perioperative outcomes, and recurrence-free and overall survival.
Of the 162 low-SES patients and 119 high-SES patients, 54% were managed in the MDC. Outside the MDC, low-SES patients were less likely to receive neoadjuvant chemotherapy and had less minimally invasive surgery, a longer OR time, less enhanced recovery participation, and more major complications (p < 0.05). No SES disparities were observed among the MDC patients. Despite similar tumor characteristics, the low-SES patients had inferior median overall survival (21 vs 32 months; p = 0.005), but the MDC appeared to eliminate this disparity. Low SES correlated with inferior survival for the non-MDC patients (17 vs 32 months; p < 0.001), but not for the MDC patients (24 vs 25 months; p = 0.33). These findings persisted in the multivariable analysis.
A pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival for low-SES patients.
全国性研究已表明，胰腺癌患者的治疗和生存情况因社会经济地位（SES）而异。本研究旨在确定基于患者SES的围手术期管理和结局的具体差异，并研究多学科诊所（MDC）在减轻任何差异方面的作用。
该研究分析了在一个大型医院系统中接受胰十二指肠切除术治疗胰腺导管腺癌的患者。将患者分为高SES组和低SES组，以及是否由作者的胰腺癌MDC进行管理。该研究比较了疾病特征、多模式治疗的接受情况、围手术期结局、无复发生存期和总生存期的差异。
在162例低SES患者和119例高SES患者中，54%在MDC接受管理。在MDC之外，低SES患者接受新辅助化疗的可能性较小，微创手术较少，手术时间较长，参与加速康复的情况较少，主要并发症较多（p<0.05）。在MDC患者中未观察到SES差异。尽管肿瘤特征相似，但低SES患者的中位总生存期较差（21个月对32个月；p=0.005），但MDC似乎消除了这种差异。低SES与非MDC患者较差的生存期相关（17个月对32个月；p<0.001），但与MDC患者无关（24个月对25个月；p=0.33）。这些发现在多变量分析中持续存在。
胰腺癌MDC使治疗决策标准化，消除手术结局的差异，并改善低SES患者的生存情况。
