Suraju Mohammed O, Kahl Amanda R, Nayyar Apoorve, Turaczyk-Kolodziej David, McCracken Ana, Gordon Darren, Freischlag Kyle, Borbon Luis, Nash Sarah, Aziz Hassan
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
Iowa Cancer Registry, Iowa City, IA, United States; Department of Epidemiology, University of Iowa, Iowa City, IA, United States.
J Gastrointest Surg. 2024 Dec;28(12):1994-2000. doi: 10.1016/j.gassur.2024.09.013. Epub 2024 Sep 16.
Although advancements in surgical planning and multidisciplinary care have improved the survival of patients with hepatopancreatic cancers in recent years, the impact of the rurality of patient residence on care received and survival is not well known. We aimed to assess the association between the rurality of a patient's residence and cancer-specific survival outcomes among patients with hepatocellular carcinoma (HCC) and pancreatic cancer (PC) in Iowa, hypothesizing that patients in rural areas would experience lower survival.
Adult patients diagnosed with HCC or PC between 2010 and 2020 were identified using the Iowa Cancer Registry. Chi-square tests were used to compare categorical variables by rural/urban status. Logistic regression was used to examine factors associated with receiving surgery. Multivariable-adjusted Cox proportional hazards regression was used to determine associations with cancer-specific mortality.
Of 1877 patients with HCC, 58%, 27%, and 16% resided in metropolitan, micropolitan, and rural areas, respectively. Approximately 70% of patients in rural areas traveled ≥50 miles for definitive care. Additionally, those residing in rural areas had the highest proportion of patients receiving definitive care at non-Commission on Cancer (CoC) centers (12.6% metro vs 14% micro vs 22.2% rural, P < .001). In a multivariable-adjusted analysis of patients with stage I to III disease, definitive care at a non-CoC center was independently associated with lower odds of surgery (odds ratio [OR] = 0.23; 95% CI, 0.12-0.45; P < .0001) and higher mortality risk (OR = 1.39; 95% CI, 1.07-1.79; P = .01), though rural residence was not. For PC, 5465 patients were diagnosed, and 51%, 28%, and 20% resided in metropolitan, micropolitan, and rural areas, respectively. Similar to HCC, although rural residence was neither associated with odds of surgery nor with mortality risk, receiving definitive care at non-CoC accredited centers was associated with significantly lower odds of receiving surgery (OR = 0.17; 95% CI, 0.11-0.26; P < .0001) and higher mortality risk (OR = 1.48; 95% CI, 1.23-1.77; P < .0001).
Rural residents with hepatopancreatic cancer have the highest proportion of patients receiving definitive care at non-CoC centers, which is associated with lower odds of receiving surgery and higher odds of mortality. This highlights the importance of standardizing complex cancer care and the need to foster collaboration between specialized and non-specialized centers.
尽管近年来手术规划和多学科护理的进展提高了肝胰腺癌患者的生存率，但患者居住地区的乡村性质对所接受的护理和生存的影响尚不清楚。我们旨在评估爱荷华州肝细胞癌（HCC）和胰腺癌（PC）患者居住地区的乡村性质与癌症特异性生存结果之间的关联，假设农村地区的患者生存率较低。
使用爱荷华州癌症登记处确定2010年至2020年间诊断为HCC或PC的成年患者。采用卡方检验按农村/城市状况比较分类变量。使用逻辑回归分析与接受手术相关的因素。多变量调整的Cox比例风险回归用于确定与癌症特异性死亡率的关联。
在1877例HCC患者中，分别有58%、27%和16%居住在大都市、小都市和农村地区。农村地区约70%的患者前往≥50英里外接受确定性治疗。此外，居住在农村地区的患者在非癌症委员会（CoC）认证中心接受确定性治疗的比例最高（大都市地区为城12.6%，小都市地区为14%，农村地区为22.2%，P <.001）。在对I至III期疾病患者的多变量调整分析中，在非CoC中心接受确定性治疗与手术几率较低（优势比[OR]=0.23；95%置信区间，0.12 - 0.45；P <.0001）和较高的死亡风险（OR = 1.39；95%置信区间，1.07 - 1.79；P = 0.01）独立相关，尽管居住在农村地区并非如此。对于PC，共诊断出5465例患者，分别有51%、28%和20%居住在大都市、小都市和农村地区。与HCC相似，尽管居住在农村地区与手术几率和死亡风险均无关联，但在非CoC认证中心接受确定性治疗与接受手术的几率显著降低（OR = 0.17；9%置信区间区间，0.11 - 0.26；P <.0001）和较高的死亡风险（OR = 1.48；95%置信区间，1.23 - 1.77；P <.0001）相关。
患有肝胰腺癌的农村居民在非CoC中心接受确定性治疗的患者比例最高，这与接受手术的几率较低和死亡几率较高相关。这凸显了标准化复杂癌症护理的重要性以及促进专业和非专业中心之间合作的必要性。
