Department of Surgery, Memorial Healthcare System, Hollywood, FL, USA.
Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
Ann Surg Oncol. 2022 Dec;29(13):8239-8248. doi: 10.1245/s10434-022-12388-1. Epub 2022 Aug 16.
Textbook oncologic outcome (TOO) is a composite outcome measure realized when all desired short-term quality metrics are met after an oncologic operation. This study examined the incidence and impact of achieving a TOO among patients undergoing resection of gastric adenocarcinoma.
The 2004-2016 National Cancer Database was queried for patients who underwent curative gastrectomy. Textbook oncologic outcome was defined as having met five metrics: R0 resection, American Joint Committee on Cancer-compliant lymph node evaluation (n ≥ 15), no prolonged hospital stay (< 75th percentile by year), no 30-day readmission, and receipt of guideline-accordant systemic therapy.
Of 34,688 patients identified, 8249 (23.8 %) achieved TOO. The patients for whom TOO was achieved were more likely to have traveled farther (p < 0.001) and received care in an academic (p < 0.001) or very high case-volume facility (p < 0.001). The TOO group had a significanty higher median overall survival (OS) than the non-TOO group (80.5 vs 35.3 months; p < 0.001). The Kaplan-Meier curve showed that at 12 months, the survival probability estimate was 92 % for the TOO group versus 77 % for the non-TOO group. At 60 months (long-term survival), survival probability estimates remained higher for the TOO group (57 % vs 38 %). The results of the multivariate Cox regression model found that TOO attainment was significantly associated with a reduced risk of death (hazard ratio, 0.82; p < 0.001).
The TOO measure is associated with improved OS and reduced risk of death after gastrectomy for gastric adenocarcinoma. Unfortunately, in this study, TOO was obtained in only 23.8 % of cases.
教科书式肿瘤学结局（TOO）是一种综合结局衡量指标，在完成肿瘤手术后，所有期望的短期质量指标都得到满足时实现。本研究检验了在接受胃腺癌切除术的患者中实现 TOO 的发生率和影响。
对 2004-2016 年国家癌症数据库中接受根治性胃切除术的患者进行了查询。教科书式肿瘤学结局的定义是满足以下五个指标：R0 切除、符合美国癌症联合委员会（AJCC）要求的淋巴结评估（n≥15）、无延长住院时间（按年份的 75 分位数计算）、30 天内无再入院、以及接受符合指南的全身治疗。
在确定的 34688 名患者中，有 8249 名（23.8%）实现了 TOO。实现 TOO 的患者更有可能长途旅行（p<0.001），并在学术（p<0.001）或高病例量的医疗机构（p<0.001）接受治疗。TOO 组的中位总生存期（OS）显著长于非 TOO 组（80.5 与 35.3 个月；p<0.001）。Kaplan-Meier 曲线显示，在 12 个月时，TOO 组的生存概率估计值为 92%，而非 TOO 组为 77%。在 60 个月（长期生存）时，TOO 组的生存概率估计值仍然较高（57%与 38%）。多变量 Cox 回归模型的结果发现，TOO 的实现与降低死亡风险显著相关（风险比，0.82；p<0.001）。
TOO 测量与胃腺癌胃切除术后 OS 的改善和死亡风险的降低相关。不幸的是，在本研究中，仅 23.8%的病例获得了 TOO。
