高容量中心的治疗与胰腺神经内分泌肿瘤患者结局的改善相关：基于人群水平的分析。

Care at high-volume centers is associated with improved outcomes for patients with pancreatic neuroendocrine tumors: A population-level analysis.

机构信息

Department of Surgery, Division of General Surgery, Oregon Heath & Science University, Portland, Oregon, USA.

Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA.

出版信息

J Surg Oncol. 2023 May;127(6):956-965. doi: 10.1002/jso.27225. Epub 2023 Mar 11.

DOI:10.1002/jso.27225

PMID:36905335

Abstract

BACKGROUND AND OBJECTIVES

Primary resection and debulking of liver metastases have been associated with improved survival in pancreatic neuroendocrine tumors (PNETs). The treatment patterns and outcomes differences between low-volume (LV) institutions and high-volume (HV) institutions remains unstudied.

METHODS

A statewide cancer registry was queried for patients with nonfunctional PNET from 1997 to 2018. LV institutions were defined as treating <5 newly diagnosed patients with PNET per year, while HV institutions treated ≥5.

RESULTS

We identified 647 patients: 393 with locoregional (n = 236 HV care, n = 157 LV care) and 254 with metastatic disease (n = 116 HV care, n = 138 LV care). Patients with HV care had improved disease-specific survival (DSS) compared to patients with LV care for both locoregional (median 63 vs. 32 months, p < 0.001) and metastatic disease (median 25 vs. 12 months, p < 0.001). In patients with metastatic disease, primary resection (hazard ratio [HR]: 0.55, p = 0.003) and HV institution (HR: 0.63, p = 0.002) were independently associated with improved DSS. Furthermore, diagnosis at a HV center was independently associated with higher odds of receiving primary site surgery (odds ratio [OR]: 2.59, p = 0.01) and metastasectomy (OR: 2.51, p = 0.03).

CONCLUSIONS

Care at HV centers is associated with improved DSS in PNET. We recommend referral of all patients with PNETs to HV centers.

摘要

背景与目的

原发肿瘤切除术和肿瘤减灭术与胰腺神经内分泌肿瘤（pancreatic neuroendocrine tumors，PNETs）患者的生存改善相关。低容量（low-volume，LV）机构和高容量（high-volume，HV）机构之间的治疗模式和结果差异尚未得到研究。

方法

通过全州癌症登记处，从 1997 年至 2018 年检索非功能性 PNET 患者。低容量机构定义为每年治疗<5 例新诊断的 PNET 患者，而高容量机构则治疗≥5 例。

结果

共纳入 647 例患者：局部区域疾病 393 例（236 例 HV 治疗，157 例 LV 治疗），转移性疾病 254 例（116 例 HV 治疗，138 例 LV 治疗）。与 LV 治疗相比，HV 治疗患者的疾病特异性生存率（disease-specific survival，DSS）更高，无论是局部区域疾病（中位 63 个月比 32 个月，p<0.001）还是转移性疾病（中位 25 个月比 12 个月，p<0.001）。在转移性疾病患者中，原发肿瘤切除术（风险比 [hazard ratio，HR]：0.55，p=0.003）和 HV 机构（HR：0.63，p=0.002）与改善 DSS 独立相关。此外，在 HV 中心诊断与接受原发灶手术（优势比 [odds ratio，OR]：2.59，p=0.01）和转移灶切除术（OR：2.51，p=0.03）的可能性更高独立相关。