新辅助化疗,病例数量和晚期卵巢癌的死亡率
Mary Kathryn Abel1, Varvara Mazina1, Amy J Bregar1
1Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston.
JAMA network open
|July 25, 2025
概括
在晚期卵巢癌手术中使用新辅助化疗 (NACT) 显著降低了90天的死亡率,特别是在大量的医院. 较高的NACT率提高了生存率,特别是受益于在高体积中心接受治疗的患者.
科学领域:
- 妇科瘤学 妇科瘤学
- 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:
- 对于晚期卵巢癌的细胞还原性手术,在体积较小的医院中死亡率更高.
- 新辅助化疗 (NACT) 可以减少手术复杂性和死亡率.
- 根据医院的数量,NACT利用率与外科手术结果之间的关联还没有得到很好的定义.
研究的目的:
- 确定增加NACT使用是否与手术后死亡率降低和细胞还原手术后生存率改善相关.
- 为了调查这种关联,特别是在低体积医院内.
主要方法:
- 在2010-2019年期间,对70707名患有III/IV期卵巢癌的患者进行了横截面研究.
- 对癌症计划层面的NACT率和医院年度外科手术体积的分析.
- 测量结果:经过90天的术后死亡率和60个月的预期寿命.
主要成果:
- 较高的NACT率与较低的90天外科死亡率有关,医院体积的显著相互作用 (P < .001).
- 较高的NACT使用率 (59%) 显示,与较低体积中心 (OR,0.48) 相比,高体积中心 (OR,0.26) 的死亡率降低更大.
- 在高容量中心使用高NACT,60个月的预期寿命提高了4.0个月.
结论:
- 在高NACT利用率的高体积中心进行治疗与最低的90天外科死亡率有关.
- 在高体积环境中使用高NACT与晚期卵巢癌患者的长期生存率的改善有关.
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