Caruso Giuseppe, Ainio Chiara, Fumagalli Diletta, Reynolds Evelyn A, Nasioudis Dimitrios, Mc Gree Michaela E, Fought Angela J, Giuntoli Robert L, Mariani Andrea, 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 Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2025 Sep;200:33-43. doi: 10.1016/j.ygyno.2025.07.009. Epub 2025 Jul 21.
Textbook Oncologic Outcome (TOO) is a composite quality measure in surgical oncology associated with improved overall survival (OS). This study evaluated the prognostic impact of TOO and identified factors associated with achieving TOO in endometrial cancer (EC).
Patients undergoing surgery for presumed early-stage EC between 2018 and 2020 were identified in the National Cancer Database. TOO was defined as achieving all six of the following metrics: minimally invasive hysterectomy, required lymph node assessment, hospital stay ≤1 day, no unplanned 30-day hospital readmission, appropriate adjuvant therapy, and no 90-day mortality. Kaplan-Meier and Cox regression analyses were used to evaluate 5-year OS by TOO status. Logistic regression was used to identify factors associated with TOO.
Among 66,416 patients, 81.0 % achieved TOO (TOO+). TOO+ patients had significantly improved 5-year OS (90.3 % vs 76.4 %; adjusted hazard ratio 0.46, 95 % CI 0.43-0.49). Factors associated with lower likelihood to achieve TOO included age > 75 years (vs <60; adjusted odds ratio [aOR] 0.58, 95 % CI 0.54-0.62), Black race (vs White, aOR 0.74, 95 % CI 0.69-0.79), government insurance (vs private; aOR 0.68, 95 % CI 0.65-0.72), and non-endometrioid histology (aOR 0.62, 95 % CI, 0.58-0.67). Higher hospital volume was associated with a higher likelihood of achieving TOO (median ≥84 vs ≤32 cases/year; aOR 1.54, 95 % CI 1.45-1.64).
TOO in EC surgery is strongly associated with overall survival and may serve as a benchmark goal for assessing quality of care. Disparities related to race, insurance status, and hospital volume highlight the need to expand access to high-quality care nationally.
《肿瘤学教科书结局》（TOO）是外科肿瘤学中的一项综合质量指标，与总体生存率（OS）的提高相关。本研究评估了TOO的预后影响，并确定了子宫内膜癌（EC）中与实现TOO相关的因素。
在国家癌症数据库中识别出2018年至2020年间因疑似早期EC接受手术的患者。TOO被定义为达到以下所有六项指标：微创子宫切除术、必要的淋巴结评估、住院时间≤1天、无计划外30天再次入院、适当的辅助治疗以及无90天死亡率。采用Kaplan-Meier和Cox回归分析按TOO状态评估5年OS。采用逻辑回归确定与TOO相关的因素。
在66416例患者中，81.0%实现了TOO（TOO+）。TOO+患者的5年OS显著改善（90.3%对76.4%；调整后风险比0.46，95%CI 0.43-0.49）。与实现TOO可能性较低相关的因素包括年龄>75岁（对<60岁；调整后优势比[aOR]0.58，95%CI 0.54-0.62）、黑人种族（对白人，aOR 0.74，95%CI 0.69-0.79）、政府保险（对私人保险；aOR 0.68，95%CI 0.65-0.72）以及非子宫内膜样组织学（aOR 0.62，95%CI 0.58-0.67）。更高的医院手术量与实现TOO的可能性更高相关（中位数≥84例/年对≤32例/年；aOR 1.54，95%CI 1.45-1.64）。
EC手术中的TOO与总体生存率密切相关，可作为评估医疗质量的基准目标。与种族、保险状况和医院手术量相关的差异凸显了在全国范围内扩大获得高质量医疗服务机会的必要性。
