Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Surg Oncol. 2023 Jul;30(7):4377-4387. doi: 10.1245/s10434-023-13308-7. Epub 2023 Mar 25.
Pancreatic ductal adenocarcinoma (PDAC) requires complex multidisciplinary care. European evidence suggests potential benefit from regionalization, however, data characterizing the ideal setting in the United States are sparse. Our study compares the significance of four hospital designations on guideline-concordant care (GCC) and overall survival (OS).
The Texas Cancer Registry was queried for 17,071 patients with PDAC treated between 2004 and 2015. Clinical data were correlated with hospital designations: NCI designated (NCI), high volume (HV), safety net (SNH), and American College of Surgeons Commission on Cancer accredited (ACS). Univariable (UVA) and multivariable (MVA) logistic regression were used to assess associations with GCC [on the basis of National Comprehensive Cancer Network (NCCN) recommendations]. Cox regression analysis assessed survival.
Only 43% of patients received GCC. NCI had the largest associated risk reduction (HR 0.61, CI 0.58-0.65), followed by HV (HR 0.87, CI 0.83-0.90) and ACS (HR 0.91, CI 0.87-0.95). GCC was associated with a survival benefit in the full (HR 0.75, CI 0.69-0.81) and resected cohort (HR 0.74, CI 0.68-0.80). NCI (OR 1.52, CI 1.37-1.70), HV (OR 1.14, CI 1.05-1.23), and SNH (OR 0.78, CI 0.68-0.91) all correlated with receipt of GCC. For resected patients, ACS (OR 0.63, CI 0.50-0.79) and SNH (OR 0.50, CI 0.33-0.75) correlate with GCC.
A total of 43% of patients received GCC. Treatment at NCI and HV correlated with improved GCC and survival. Including GCC as a metric in accreditation standards could impact survival for patients with PDAC.
胰腺导管腺癌 (PDAC) 需要复杂的多学科护理。欧洲的证据表明区域化具有潜在益处，然而，美国描述理想环境的数据却很少。我们的研究比较了四种医院指定对指南一致护理 (GCC) 和总生存期 (OS) 的意义。
德克萨斯癌症登记处对 2004 年至 2015 年间治疗的 17071 例 PDAC 患者进行了查询。将临床数据与医院指定相关联：NCI 指定 (NCI)、高容量 (HV)、安全网 (SNH) 和美国外科医师学院癌症委员会认证 (ACS)。使用单变量 (UVA) 和多变量 (MVA) 逻辑回归评估与 GCC 的关联 [基于国家综合癌症网络 (NCCN) 建议]。Cox 回归分析评估了生存情况。
只有 43%的患者接受了 GCC。NCI 的关联风险降低最大 (HR 0.61，CI 0.58-0.65)，其次是 HV (HR 0.87，CI 0.83-0.90) 和 ACS (HR 0.91，CI 0.87-0.95)。在全组 (HR 0.75，CI 0.69-0.81) 和切除组 (HR 0.74，CI 0.68-0.80) 中，GCC 与生存获益相关。NCI (OR 1.52，CI 1.37-1.70)、HV (OR 1.14，CI 1.05-1.23) 和 SNH (OR 0.78，CI 0.68-0.91) 均与 GCC 的接受相关。对于切除的患者，ACS (OR 0.63，CI 0.50-0.79) 和 SNH (OR 0.50，CI 0.33-0.75) 与 GCC 相关。
共有 43%的患者接受了 GCC。在 NCI 和 HV 治疗与改善的 GCC 和生存相关。将 GCC 作为认证标准中的一项指标可能会影响 PDAC 患者的生存。
