与不接受局部晚期直肠癌手术相关的因素:一个NCDB倾向匹配分析
Sophia Y Chen1, Shannon N Radomski1, Miloslawa Stem1
1Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Surgery
|October 18, 2023
概括
局部晚期直肠癌的手术率正在下降,与年龄,种族和收入相关的拒绝率增加. 新辅助治疗加上手术提供了最好的生存结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 局部晚期直肠癌 (LARC) 的标准治疗包括新辅助化学辐射,手术和辅助化疗.
- 最近的趋势表明,对LARC患者的外科治疗方法有所转变.
研究的目的:
- 分析LARC手术治疗的趋势.
- 确定影响决定放弃手术的因素.
- 根据治疗方式来评估总体生存结果.
主要方法:
- 从国家癌症数据库 (2004-2019) 中对成年LARC患者的回顾性分析.
- 使用了倾向性得分匹配.
- 多变量逻辑回归确定了与不接受手术相关的因素.
- 卡普兰-梅尔和日志等级测试评估了5年整体存活率.
主要成果:
- 对于LARC的手术率从2006年的95.61%下降到2019年的92.29%,而拒绝率增加.
- 与避免手术相关的因素包括年龄较大,黑人种族,较高的并发症得分,II期癌症,较低的收入和非私人保险.
- 经过手术后的新辅助治疗在所有阶段都产生了最佳的5年整体存活率.
结论:
- 在美国,LARC的指导方针一致的外科护理存在着令人担忧的下降,与持续的社会经济差异相伴.
- 了解患者的障碍,并引导适当的候选人进行手术至关重要.
- 标准化和评估LARC护理是必要的,以确保最佳的患者结果.
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