Surgical Referral for Colorectal Liver Metastases: A Population-Based Survey
Surgical Referral for Colorectal Liver Metastases: A Population-Based Survey
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DOI：
10.1245/s10434-014-4318-x
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发表时间：
2015-07-01
影响因子：
3.7
通讯作者：
Wong, Sandra L.
中科院分区：
文献类型：
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作者：
Krell, Robert W.;Reames, Bradley N.;Wong, Sandra L.
结直肠癌肝转移（CLM）患者的手术切除率较低。虽然利用率不足的原因知之甚少，提供者对手术转诊的态度可能是贡献。我们试图了解医学肿瘤学家对CLM转诊的看法。对美国密歇根州治疗结直肠癌的医学肿瘤学家进行了调查。我们描述了受访者对CLM肝切除术的临床和肿瘤相关禁忌症的态度，以及使用基于病例的情景的转诊和治疗偏好。然后，我们评估了医生之间的实践特征和治疗偏好，共收到112份合格的回复（回复率为46%）。近40%的受访者报告在他们的实践领域没有肝脏外科医生。肝切除术的常见禁忌症包括肝外疾病（80.3%）、体力状态差（77.7%）、存在> 4个转移灶（62.5%）、双叶转移灶（43.8%）和转移灶大小> 5 cm（40.2%）。与高转诊医生相比，低转诊医生同样可能转诊复发风险极低的患者（89.3 vs. 98.3%; p = 0.099），但不太可能转诊中度风险的患者（0 vs. 82.8%; p < 0.001）。高转诊医生更可能考虑切除符合较高复发风险的情况（31.0 vs. 10.7%; p = 0.05）。我们发现CLM的手术转诊模式差异很大。许多人认为，尽管缺乏支持性数据，双叶疾病和肿瘤大小是肝脏定向治疗的禁忌症。这些发现表明迫切需要增加关于CLM管理的证据和指导的传播，也许可以通过增加肿瘤委员会的专家参与。
Surgical resection is underutilized for patients with colorectal liver metastases (CLM). Although the causes of underutilization are poorly understood, provider attitudes towards surgical referral may be contributory. We sought to understand medical oncologists' perspectives on referral for CLM.Medical oncologists who treat colorectal cancer in the US state of Michigan were surveyed. We characterized respondents' attitudes regarding clinical and tumor-related contraindications to liver resection for CLM, as well as referral and treatment preferences using case-based scenarios. We then evaluated practice characteristics and treatment preferences between physicians.A total of 112 eligible responses were received (46 % response rate). Nearly 40 % of respondents reported having no liver surgeons in their practice area. Commonly perceived contraindications to liver resection included extrahepatic disease (80.3 %), poor performance status (77.7 %), the presence of > 4 metastases (62.5 %), bilobar metastases (43.8 %), and metastasis size > 5 cm (40.2 %). Compared with high-referring physicians, low-referring physicians were just as likely to refer a patient with very low recurrence risk (89.3 vs. 98.3 %; p = 0.099), but much less likely to refer a patient with moderate risk (0 vs. 82.8 %; p < 0.001). High-referring physicians were more likely to consider resection for scenarios consistent with higher recurrence risk (31.0 vs. 10.7 %; p = 0.05).We found wide variation in surgical referral patterns for CLM. Many felt that bilobar disease and tumor size were contraindications to liver-directed therapy despite a lack of supporting data. These findings suggest an urgent need to increase dissemination of evidence and guidance regarding management for CLM, perhaps through increased specialist participation in tumor boards.