Department of Healthcare Administration, Asia University, Taichung, Taiwan.
Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Oral Dis. 2024 Apr;30(3):1128-1138. doi: 10.1111/odi.14587. Epub 2023 Apr 24.
To explore the impact of textbook outcome (TO) on long-term survival in oral cancer surgery.
In total, 386 patients with tumor resection, neck dissection (ND), and reconstruction between 2011 and 2020 were included. TO was defined as negative margin; adequate ND; no 3-day emergency room revisit; no 30-day readmission; and length of stay ≤22 days. Multivariate Cox regression was used to evaluate the impact of TO and 5-year overall survival (OS).
The TO rate was 35%. Younger age, subsite in buccal area, Charlson Comorbidity Index Score of 0, higher body mass index, higher hemoglobin, higher albumin, and unilateral ND were associated with TO. 5-year OS was 70.5% in overall TO patients and 49.0% in non-TO patients (HR, 0.47; 95% CI, 0.31-0.70; p < 0.001). Non-TO was associated with an increased mortality rate (aHR, 1.73; 95% CI, 1.14-2.63) after adjusting other factors and the result remained robust with inverse probability of treatment weighting analysis. The impact of TO on OS was more significant in age <60, advanced stage, and diagnosis year before 2018.
Not achieving TO in oral cancer surgery was associated with worse long-term outcome. TO could be used as a proxy for surgical quality improvement.
探讨教科书结局（TO）对口腔癌手术长期生存的影响。
共纳入 2011 年至 2020 年间行肿瘤切除术、颈清扫术（ND）和重建术的 386 例患者。TO 定义为阴性切缘；充分的 ND；术后 3 天内无急诊室复诊；术后 30 天内无再入院；且住院时间≤22 天。采用多变量 Cox 回归评估 TO 和 5 年总生存率（OS）的影响。
TO 率为 35%。年龄较小、颊部亚部位、Charlson 合并症指数评分 0 分、较高的体重指数、较高的血红蛋白、较高的白蛋白和单侧 ND 与 TO 相关。总体 TO 患者的 5 年 OS 为 70.5%，而非 TO 患者的 5 年 OS 为 49.0%（HR，0.47；95%CI，0.31-0.70；p<0.001）。在调整其他因素后，非 TO 与死亡率增加相关（aHR，1.73；95%CI，1.14-2.63），且通过逆概率治疗加权分析结果仍然稳健。TO 对 OS 的影响在年龄<60 岁、晚期和 2018 年前诊断的患者中更为显著。
口腔癌手术中未达到 TO 与长期预后较差相关。TO 可作为手术质量改进的替代指标。
