年龄和合并症对局部胰腺癌预后的影响：一项美国回顾性队列分析及其对手术集中化的启示
The impact of age and comorbidity on localized pancreatic cancer outcomes: A US retrospective cohort analysis with implications for surgical centralization.
作者信息
Powers Benjamin D, Allenson Kelvin, Perone Jennifer A, Thompson Zachary, Boulware David, Denbo Jason W, Kim Joon-Kyung, Permuth Jennifer B, Pimiento Jose, Hodul Pamela J, Malafa Mokenge P, Kim Dae Won, Fleming Jason B, Anaya Daniel A
机构信息
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America.
Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States of America.
出版信息
Surg Open Sci. 2023 Feb 11;12:14-21. doi: 10.1016/j.sopen.2023.02.001. eCollection 2023 Mar.
INTRODUCTION
Age and comorbidity are independently associated with worse outcomes for pancreatic adenocarcinoma (PDAC). However, the effect of combined age and comorbidity on PDAC outcomes has rarely been studied. This study assessed the impact of age and comorbidity (CACI) and surgical center volume on PDAC 90-day and overall survival (OS).
METHODS
This retrospective cohort study used the National Cancer Database from 2004 to 2016 to evaluate resected stage I/II PDAC patients. The predictor variable, CACI, combined the Charlson/Deyo comorbidity score with additional points for each decade lived ≥50 years. The outcomes were 90-day mortality and OS.
RESULTS
The cohort included 29,571 patients. Ninety-day mortality ranged from 2 % for CACI 0 to 13 % for CACI 6+ patients. There was a negligible difference (1 %) in 90-day mortality between high- and low-volume hospitals for CACI 0-2 patients; however, there was greater difference for CACI 3-5 (5 % vs. 9 %) and CACI 6+ (8 % vs. 15 %). The overall survival for CACI 0-2, 3-5, and 6+ cohorts was 24.1, 19.8, and 16.2 months, respectively. Adjusted overall survival showed a 2.7 and 3.1 month survival benefit for care at high-volume vs. low-volume hospitals for CACI 0-2 and 3-5, respectively. However, there was no OS volume benefit for CACI 6+ patients.
CONCLUSIONS
Combined age and comorbidity are associated with short- and long-term survival for resected PDAC patients. A protective effect of higher-volume care was more impactful for 90-day mortality for patients with a CACI above 3. A centralization policy based on volume may have greater benefit for older, sicker patients.
KEY MESSAGE
Combined comorbidity and age are strongly associated with 90-day mortality and overall survival for resected pancreatic cancer patients. When assessing the impact of age and comorbidity on resected pancreatic adenocarcinoma outcomes, 90-day mortality was 7 % higher (8 % vs. 15 %) for older, sicker patients treated at high-volume vs. low-volume centers but only 1 % (3 % vs. 4 %) for younger, healthier patients.
引言
年龄和合并症各自都与胰腺导管腺癌（PDAC）较差的预后相关。然而，年龄与合并症共同对PDAC预后产生的影响却鲜有研究。本研究评估了年龄与合并症（CACI）以及手术中心手术量对PDAC患者90天生存率和总生存期（OS）的影响。
方法
这项回顾性队列研究使用了2004年至2016年的国家癌症数据库，以评估I/II期接受手术切除的PDAC患者。预测变量CACI将查尔森/戴约合并症评分与每活过一个十年（≥50岁）的额外分数相结合。观察指标为90天死亡率和总生存期。
结果
该队列包括29,571例患者。90天死亡率在CACI为0的患者中为2%，在CACI为6及以上的患者中为13%。对于CACI为0 - 2的患者，高手术量医院和低手术量医院之间的90天死亡率差异可忽略不计（1%）；然而，对于CACI为3 - 5的患者（5%对9%）和CACI为6及以上的患者（8%对15%），差异更大。CACI为0 - 2、3 - 5和6及以上队列的总生存期分别为24.1个月、19.8个月和16.2个月。校正后的总生存期显示，对于CACI为0 - 2和3 - 5的患者，在高手术量医院接受治疗比在低手术量医院接受治疗分别有2.7个月和3.1个月的生存获益。然而，对于CACI为6及以上的患者，手术量并未带来总生存期的获益。
结论
年龄与合并症共同影响接受手术切除的PDAC患者的短期和长期生存。对于CACI高于3的患者，更高手术量治疗的保护作用对90天死亡率的影响更大。基于手术量的集中化政策可能对年龄较大、病情较重的患者有更大益处。
关键信息
合并症与年龄共同对接受手术切除的胰腺癌患者的90天死亡率和总生存期有强烈影响。在评估年龄和合并症对接受手术切除的胰腺导管腺癌预后的影响时，在高手术量中心与低手术量中心接受治疗的年龄较大、病情较重的患者，其90天死亡率要高7%（8%对15%），但年龄较小、病情较轻的患者仅高1%（3%对4%）。
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