癌症委员会（CoC）认证是否能减轻局部直肠癌治疗碎片化对临床结局的影响？
Does commission on cancer (CoC) accreditation mitigate the effect of care fragmentation on clinical outcome in localized rectal cancer?
机构信息
Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA.
出版信息
Am J Surg. 2024 Apr;230:63-67. doi: 10.1016/j.amjsurg.2023.12.024. Epub 2023 Dec 21.
BACKGROUND
Studies of fragmented care (FC) in rectal cancer have not adjusted for indicators of hospital quality and may misrepresent the effects of FC.
METHODS
We queried the National Cancer Database to identify patients undergoing care for clinical stage II and III rectal adenocarcinoma between 2006 and 2019. Those undergoing FC were sub-categorized based on whether (FC CoC) or not (FC non-CoC) they received systemic therapy at CoC accredited facilities.
RESULTS
44,339 patients met inclusion criteria; 23,921 (54 %) underwent FC, 16,929 (71 %) FC non-CoC. Differences in utilization of neoadjuvant therapy (92.3 % vs 89.7 % vs 89.5 %, p < 0.01) and 5-year overall survival (76.1 vs 75.5 vs 74.1 %, p < 0.01) between treatment cohorts were marginal.
CONCLUSION
In patients undergoing multimodality therapy for rectal cancer, care fragmentation is not associated with long-term clinical outcome. Decisions regarding where these patients go for systemic therapy may be safely made on the basis of ease of access.
背景
针对直肠癌碎片化治疗（FC）的研究并未调整医院质量指标，可能会对 FC 的影响产生误判。
方法
我们查询了国家癌症数据库，以确定在 2006 年至 2019 年间接受 II 期和 III 期直肠腺癌治疗的患者。根据他们是否在获得 CoC 认证的机构接受系统治疗（FC CoC）或未接受（FC non-CoC），将接受 FC 的患者进行细分。
结果
44339 名患者符合纳入标准；其中 23921 名（54%）接受 FC 治疗，16929 名（71%）接受 FC non-CoC 治疗。在新辅助治疗的应用（92.3% vs 89.7% vs 89.5%，p<0.01）和 5 年总生存率（76.1% vs 75.5% vs 74.1%，p<0.01）方面，治疗队列之间存在差异。
结论
在接受多模式治疗的直肠癌患者中，治疗的碎片化与长期临床结局无关。关于这些患者去哪里接受系统治疗的决策，可以根据方便程度安全地做出。
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