医院安全网负担状况对人乳头瘤病毒阳性口咽癌患者的影响。

The Impact of Hospital Safety-Net Burden Status on Patients with HPV-Positive Oropharyngeal Cancer.

作者信息

Gilja Shivee, Kumar Arvind, Kapustin Danielle, Su Vivian, Rubin Samuel J, Chai Raymond, Roof Scott A, Khan Mohemmed N

机构信息

Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA.

出版信息

Laryngoscope. 2024 Apr;134(4):1733-1740. doi: 10.1002/lary.31131. Epub 2023 Nov 7.

DOI:10.1002/lary.31131

PMID:37933810

Abstract

OBJECTIVES

The objective of this study was to compare treatment characteristics and outcomes between patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety-net burden status.

METHODS

Patients with cT1-4, N0-3, M0 HPV-positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety-net burden status, defined as the percentage of uninsured and Medicaid-insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0-25th percentile), medium burden (MBH: 25th-75th percentile), or high burden (HBH: 75th-100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable-adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis.

RESULTS

Of the 19,810 patients with cT1-4, N0-3, M0 HPV-positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable-adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12-1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24-0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13-1.43, p < 0.001).

CONCLUSION

These findings highlight underlying disparities at higher safety-net burden facilities that impact patterns of care and outcomes for patients with OPSCC.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1733-1740, 2024.

摘要

目的

本研究的目的是比较在不同安全网负担状况的医院接受治疗的人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）患者的治疗特征和结局。

方法

纳入接受根治性手术或放疗的cT1-4、N0-3、M0 HPV阳性OPSCC患者。根据其治疗医院的安全网负担状况对患者进行分组，安全网负担状况定义为该机构治疗的OPSCC未参保和医疗补助参保患者的百分比，并分为低负担（LBH：第0至25百分位数）、中等负担（MBH：第25至75百分位数）或高负担（HBH：第75至100百分位数）。主要结局是手术与放疗的初始治疗，采用多变量调整逻辑回归进行评估。次要结局包括经口机器人手术与开放手术入路，以及采用Cox比例风险分析评估总生存期。

结果

本研究纳入的19810例cT1-4、N0-3、M0 HPV阳性OPSCC患者中，4921例（24.8%）在低负担医院接受治疗，12201例（61.6%）在中等负担医院接受治疗，2688例（13.6%）在高负担医院接受治疗。在多变量调整分析中，与在低负担医院治疗相比，在高负担医院治疗与放疗比手术治疗更频繁相关（比值比：1.26，95%置信区间：1.12-1.40，p＜0.001）。对于接受手术的患者，与在低负担医院治疗的患者相比，高负担医院的患者经口机器人手术频率较低（比值比：0.30，95%置信区间0.24-0.38，p＜0.001）。高负担医院治疗的患者的总生存期比低负担医院治疗的患者差（风险比：1.27，95%置信区间1.13-1.43，p＜0.001）。