Caruso Giuseppe, Langstraat Carrie L, Kumar Amanika, McGree Michaela E, Fought Angela J, Nasioudis Dimitrios, Aletti Giovanni D, Colombo Nicoletta, Giuntoli Robert L, Cliby William A
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA; Division of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2024 Dec;191:86-94. doi: 10.1016/j.ygyno.2024.09.018. Epub 2024 Oct 3.
Textbook oncologic outcome (TOO) has been validated in surgical oncology as a composite quality measure correlated with oncologic outcomes. We aimed to assess the association between TOO and overall survival (OS) in patients undergoing primary treatment for advanced epithelial tubo-ovarian cancer (AEOC).
Patients undergoing surgery for AEOC between 2008 and 2019 were identified in the National Cancer Database (NCDB). Primary debulking surgery (PDS) and interval debulking surgery (IDS) cohorts were analyzed separately. TOO was defined as achieving complete debulking, length of hospital stay <10 days, no 30-day readmission, no death within 90 days, and initiation of adjuvant chemotherapy within 42 days. The Kaplan-Meier method was used to estimate 5-year OS by TOO status and Cox regression to evaluate the relationship between TOO and death within 5 years.
A total of 21,657 patients were included: 51.4% in the PDS cohort and 48.6% in the IDS cohort. TOO was achieved (TOO+) in 20.5% of the PDS cohort and 39.2% of the IDS cohort. For the PDS cohort, achieving TOO was associated with improved 5-year OS: 59.0% TOO+ vs. 39.5% TOO- (HR 0.53, 95% CI 0.49-0.57). For the IDS cohort, a similar benefit was seen for 5-year OS: 43.9% TOO+ vs. 31.2% TOO- (HR 0.67, 95% CI 0.63-0.70). Multivariable analysis demonstrated that patients achieving TOO were at lower risk of death within 5 years in both the PDS cohort (HR 0.58, 95% CI 0.54-0.62) and the IDS cohort (HR 0.69, 95% CI 0.65-0.73).
The TOO composite measure is associated with improved long-term survival and could be a useful quality assessment tool for patients undergoing primary treatment for AEOC, irrespective of surgical timing. This tool reflects the ability to deliver risk-based individualized decision-making using a multidisciplinary approach.
教科书式肿瘤学结局（TOO）已在外科肿瘤学中得到验证，作为一种与肿瘤学结局相关的综合质量指标。我们旨在评估TOO与晚期上皮性输卵管卵巢癌（AEOC）初次治疗患者的总生存期（OS）之间的关联。
在国家癌症数据库（NCDB）中识别出2008年至2019年间接受AEOC手术的患者。分别分析了初次肿瘤细胞减灭术（PDS）和中间肿瘤细胞减灭术（IDS）队列。TOO被定义为实现完全肿瘤细胞减灭、住院时间<10天、无30天再入院、90天内无死亡以及在42天内开始辅助化疗。采用Kaplan-Meier方法按TOO状态估计5年OS，并采用Cox回归评估TOO与5年内死亡之间的关系。
共纳入21657例患者：PDS队列占51.4%，IDS队列占48.6%。PDS队列中20.5%的患者和IDS队列中39.2%的患者实现了TOO（TOO+）。对于PDS队列，实现TOO与5年OS改善相关：TOO+组为59.0%，TOO-组为39.5%（HR 0.53，95%CI 0.49-0.57）。对于IDS队列，5年OS也有类似益处：TOO+组为43.9%，TOO-组为31.2%（HR 0.67，95%CI 0.63-0.70）。多变量分析表明，在PDS队列（HR 0.58，95%CI 0.54-0.62）和IDS队列（HR 0.69，95%CI 0.65-0.73）中，实现TOO的患者5年内死亡风险较低。
TOO综合指标与长期生存改善相关，对于接受AEOC初次治疗的患者，无论手术时机如何，都可能是一种有用的质量评估工具。该工具反映了使用多学科方法进行基于风险的个体化决策的能力。
