与胰腺癌无法恢复预期肿瘤治疗相关的因素。

Factors associated with inability to return to intended oncologic treatment in pancreatic cancer.

机构信息

Department of Surgery, Medical University of South Carolina, Clinical Sciences Building Suite 420, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.

Department of Surgery, University of Miami, 1120 NW 14(th) St f4, Miami, FL, 33136, USA.

出版信息

Am J Surg. 2022 Jul;224(1 Pt B):635-640. doi: 10.1016/j.amjsurg.2022.02.058. Epub 2022 Mar 1.

DOI:10.1016/j.amjsurg.2022.02.058

PMID:35249728

Abstract

BACKGROUND

Return to Intended Oncologic Treatment (RIOT) has been proposed as a quality metric in the care of cancer patients. We sought to define factors associated with inability to RIOT in Pancreatic Ductal Adenocarcinoma (PDAC) patients.

METHODS

The NCDB was queried for patients who underwent pancreaticoduodenectomy for pathologic stage IB, IIA, or IIB PDAC from 2010 to 2016. Multivariable binary logistic regression models identified factors associated with failure to RIOT, and Kaplan-Meier survival analysis and Cox multivariable regression models demonstrated the impact of failure to RIOT on survival.

RESULTS

Increasing age (p < .001), Hispanic race (p = .002), pathological stage IB (p = .004) and IIA (p = .001) as compared to IIB, increasing hospital stay (p < .001), and open surgical approach (p = .024) were associated with increased risk of inability to RIOT. Male sex (p < .001), Charlson-Deyo scores of 0 (p < .001) and 1 (p = .001) as compared to >2, negative surgical margins (p = .048), receiving care at academic institutions (p = .001), and increasing institutional case volume (p = .001) were associated with improved odds of RIOT.

CONCLUSIONS

Patient features can impact RIOT and should be considered when designing multi-modality treatment strategies.

摘要

背景

在癌症患者的治疗中，已经提出了恢复预期的肿瘤治疗（RIOT）作为一种质量指标。我们旨在确定与胰腺导管腺癌（PDAC）患者无法 RIOT 相关的因素。

方法

从 2010 年至 2016 年，在 NCDB 中查询接受胰十二指肠切除术治疗病理分期 IB、IIA 或 IIB PDAC 的患者。多变量二项逻辑回归模型确定了与 RIOT 失败相关的因素，Kaplan-Meier 生存分析和 Cox 多变量回归模型表明了 RIOT 失败对生存的影响。

结果

与 RIOT 失败相关的因素包括年龄增加（p<0.001）、西班牙裔（p=0.002）、病理分期 IB（p=0.004）和 IIA（p=0.001）与 IIB 相比、住院时间延长（p<0.001）和开放式手术方法（p=0.024）。男性（p<0.001）、Charlson-Deyo 评分 0（p<0.001）和 1（p=0.001）与>2 相比、阴性手术切缘（p=0.048）、在学术机构接受治疗（p=0.001）和机构病例量增加（p=0.001）与 RIOT 成功的几率增加相关。