Department of Surgery, Weill Cornell Medicine, 525 East 68th Street, F-838, 1300 York Avenue, New York, NY, 10065, USA.
Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
World J Surg. 2022 Dec;46(12):3007-3016. doi: 10.1007/s00268-022-06712-9. Epub 2022 Aug 29.
Among surgical patients, care fragmentation (CF) is associated with worse outcomes. However, oncologic literature documents an association between high surgical volume and improved outcomes, favoring centralized cancer-surgery centers and thus predisposing to CF in patients with surgically treated tumors. We aimed to identify features associated with CF and ascertain differences in overall survival (OS) among patients with differentiated thyroid cancer (DTC).
The National Cancer Database was queried for DTC patients diagnosed from 2009 to 2017. Patients experienced CF if part of their treatment was performed outside of the reporting facility or an associated office. A multivariable logistic regression analysis identified independent features associated with CF. A Cox multivariable regression analysis assessed the impact of CF on OS. A Kaplan-Meier analysis compared survival differences between patients experiencing CF or unified care (UC).
A total of 131,620 patients were included. Among them, 70,204 (53.3%) experienced CF and 61,416 (46.7%) experienced UC. Age < 55, residing in high-income areas, and stage 3 and 4 tumors were features independently associated with CF, whereas uninsured patients were less likely to experience CF than the privately insured. The features most strongly associated with CF were treatment at highest thyroid cancer-surgery volume institutions and traveling in the top distance quartile. While patients with CF experienced minor delays in time from diagnosis to surgery, 5-year OS was improved among patients with CF compared to UC for those with Stage 1-3 disease.
Among patients with DTC, CF is associated with treatment at a highest thyroid cancer surgery volume facility and improved OS in a setting of minor treatment delays.
在外科患者中，护理碎片化（CF）与较差的预后相关。然而，肿瘤学文献记录了高手术量与改善结局之间的关联，这有利于集中的癌症手术中心，从而导致接受手术治疗的肿瘤患者 CF。我们旨在确定与 CF 相关的特征，并确定分化型甲状腺癌（DTC）患者的总生存率（OS）差异。
从 2009 年至 2017 年，国家癌症数据库被查询用于诊断 DTC 患者。如果患者的部分治疗在报告机构或相关办公室之外进行，则患者经历 CF。多变量逻辑回归分析确定与 CF 相关的独立特征。Cox 多变量回归分析评估 CF 对 OS 的影响。Kaplan-Meier 分析比较了经历 CF 或统一护理（UC）的患者之间的生存差异。
共纳入 131620 例患者。其中，70204 例（53.3%）经历 CF，61416 例（46.7%）经历 UC。年龄<55 岁、居住在高收入地区和 3 期和 4 期肿瘤是与 CF 相关的独立特征，而未参保患者比私人保险患者更不可能经历 CF。与 CF 最相关的特征是在最高甲状腺癌手术量机构接受治疗和旅行在最高距离四分位数。虽然 CF 患者从诊断到手术的时间略有延迟，但与 UC 相比，1-3 期疾病患者的 CF 患者的 5 年 OS 得到改善。
在 DTC 患者中，CF 与在最高甲状腺癌手术量机构接受治疗相关，并在轻微治疗延迟的情况下改善 OS。
