Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, Italy; Morgagni-Pierantoni Hospital, Forlì, Italy.
Division of Hematology & Oncology, Department of Medicine - Medical University of South Carolina, Charleston, SC.
Surgery. 2023 Jun;173(6):1421-1427. doi: 10.1016/j.surg.2023.01.016. Epub 2023 Mar 15.
When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma.
Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neoadjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neoadjuvant therapy.
The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P < .001). The regret of the commission was diametrically opposite to the regret of omission (P ≤ .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P ≤ .001). The nonsurgeons working in or with lower surgical volume centers (P = .010) and surgeons (P = .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy.
Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy.
在治疗有潜在可切除性的胰腺腺癌时，治疗决策取决于治疗临床医生的敏感性。面对事后可能被证明是错误的决策，他们可能会感到后悔，并希望避免这种情况。本研究应用基于后悔的决策模型来评估新辅助治疗与直接手术治疗潜在可切除胰腺腺癌的态度。
向 60 名受访者（20 名肿瘤学家、20 名胃肠病学家和 20 名外科医生）介绍了三种描述直接手术后高、中、低疾病特异性死亡率的临床情况。受访者被要求在 0（无遗憾）至 100（最大遗憾）的范围内报告他们对新辅助化疗的遗漏和过度治疗的后悔程度。应用阈值模型和多级混合回归分析受访者对新辅助治疗的态度。
低风险情况下产生的遗漏后悔最低，高风险情况下产生的遗漏后悔最高（P<0.001）。过度治疗的后悔与遗漏后悔相反（P≤0.001）。与新辅助治疗相比，直接手术更受青睐的疾病特异性阈值死亡率从低风险到高风险逐渐降低（P≤0.001）。非外科医生（工作于或与手术量较少的中心）（P=0.010）和外科医生（P=0.018）接受了更高的直接手术后疾病特异性死亡率，这导致采用新辅助治疗的可能性降低。
后悔会影响胰腺腺癌治疗决策。作为外科医生或工作于手术量较少的中心的专家，会降低推荐新辅助治疗的可能性。
