Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Int J Gynecol Cancer. 2023 May 1;33(5):741-748. doi: 10.1136/ijgc-2022-003765.
Multiple studies have assessed post-operative readmissions in advanced ovarian cancer.
To evaluate all unplanned readmissions during the primary treatment period of advanced epithelial ovarian cancer, and the impact of readmission on progression-free survival.
This was a single institution retrospective study from January 2008 to October 2018. Χ/Fisher's exact and t-test, or Kruskal-Wallis test were used. Multivariable Cox proportional hazard models were used to assess the effect of covariates in progression-free survival analysis.
A total of 484 patients (279 primary cytoreductive surgery, 205 neoadjuvant chemotherapy) were analyzed. In total, 272 of 484 (56%; 37% primary cytoreductive surgery, 32% neoadjuvant chemotherapy, p=0.29) patients were readmitted during the primary treatment period. Overall, 42.3% of the readmissions were surgery related, 47.8% were chemotherapy related, and 59.6% were cancer related but not related to surgery or chemotherapy, and each readmission could qualify for more than one reason. Readmitted patients had a higher rate of chronic kidney disease (4.1% vs 1.0%, p=0.038). Post-operative, chemotherapy, and cancer-related readmissions were similar between the two groups. However, the percentage of inpatient treatment days due to unplanned readmission was twice as high for primary cytoreductive surgery at 2.2% vs 1.3% for neoadjuvant chemotherapy (p<0.001). Despite longer readmissions in the primary cytoreductive surgery group, Cox regression analysis demonstrated that readmissions did not affect progression-free survival (HR=1.22, 95% CI 0.98 to 1.51; p=0.08). Primary cytoreductive surgery, higher modified Frailty Index, grade 3 disease, and optimal cytoreduction were associated with longer progression-free survival.
In this study, 35% of the women with advanced ovarian cancer had at least one unplanned readmission during the entire treatment time. Patients treated by primary cytoreductive surgery spent more days during readmission than those with neoadjuvant chemotherapy. Readmissions did not affect progression-free survival and may not be valuable as a quality metric.
多项研究评估了晚期卵巢癌患者的术后再入院情况。
评估晚期上皮性卵巢癌初次治疗期间所有非计划性再入院情况，并评估再入院对无进展生存期的影响。
这是一项 2008 年 1 月至 2018 年 10 月的单机构回顾性研究。采用 Χ2/Fisher 确切检验或 t 检验或 Kruskal-Wallis 检验。采用多变量 Cox 比例风险模型评估无进展生存期分析中协变量的影响。
共分析了 484 例患者（279 例行初次细胞减灭术，205 例行新辅助化疗）。在初次治疗期间，共有 484 例患者中的 272 例（56%；37%初次细胞减灭术，32%新辅助化疗，p=0.29）再入院。总体而言，42.3%的再入院与手术相关，47.8%与化疗相关，59.6%与癌症相关但与手术或化疗无关，且每次再入院都可能有多个原因。再入院患者的慢性肾脏病发生率更高（4.1%比 1.0%，p=0.038）。术后、化疗和癌症相关的再入院在两组间相似。然而，初次细胞减灭术的非计划性再入院住院天数占比是新辅助化疗的两倍，分别为 2.2%和 1.3%（p<0.001）。尽管初次细胞减灭术组的再入院时间更长，但 Cox 回归分析表明，再入院并不影响无进展生存期（HR=1.22，95%CI 0.98 至 1.51；p=0.08）。初次细胞减灭术、较高的改良脆弱指数、3 级疾病和最佳肿瘤细胞减灭术与无进展生存期延长相关。
在这项研究中，35%的晚期卵巢癌患者在整个治疗期间至少有一次非计划性再入院。行初次细胞减灭术的患者在再入院期间的住院天数多于行新辅助化疗的患者。再入院并不影响无进展生存期，可能不作为一个质量指标有价值。
