Survival impact of followup care after radical cystectomy for bladder cancer.
Survival impact of followup care after radical cystectomy for bladder cancer.
复制标题
膀胱癌根治性膀胱切除术后随访护理对生存的影响。
DOI：
10.1016/j.juro.2013.05.051
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Schootman,Mario
中科院分区：
文献类型：
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作者：
Strope,SethA;Chang,Su-Hsin;Chen,Ling;Sandhu,Gurdarshan;Piccirillo,JayF;Schootman,Mario
目的：由于膀胱癌根治性膀胱切除术后患者随访的差异很大，我们试图了解尿液和实验室检查、医生就诊和影像学对总体生存的影响。材料和方法我们使用监测流行病学和最终结果(SEER)-医疗保险数据分析了1992年至2007年在医疗服务收费人群中接受治疗的患者队列。使用倾向评分分析，我们评估了术后3个时期(围手术期（0 ~ 3个月）、早期随访（4 ~ 6个月）和后期随访（7 ~ 24个月）随访护理的时间和地理标准化支出与总生存率之间的关系。使用工具变量分析，我们按类别评估随访护理的数量对总体生存的影响，包括医生就诊、影像学检查、实验室和尿液检查。结果围手术期及早期随访均未发现生存率的提高。在后期随访中接受随访护理与低、中、高三组患者的生存率改善相关（HR分别为0.23,95% CI 0.15-0.35, HR 0.27, 95% CI 0.18-0.40和HR 0.47, 95% CI 0.31-0.71）。工具变量分析显示，仅就诊和尿检可提高生存率（HR分别为0.96,0.93-0.99和0.95,0.91-0.99）。结论根治性膀胱切除术后随访治疗可提高患者的生存率。就诊和尿检与生存率的提高有关。我们的研究结果表明，随访护理显著改善了患者的预后，但膀胱切除术后影像学检查应更加明智。
PurposeDue to substantial variation in patient followup after radical cystectomy for bladder cancer, we sought to understand the effect of urine and laboratory tests, physician visits and imaging on overall survival.Materials and MethodsWe analyzed a cohort of patients treated in the fee for service Medicare population from 1992 through 2007 using Surveillance Epidemiology and End Results (SEER)-Medicare data. Using propensity score analysis, we assessed the relationship between time and geography standardized expenditures on followup care and overall survival during 3 postoperative periods, including perioperative (0 to 3 months), early followup (4 to 6 months) and later followup (7 to 24 months). Using instrumental variable analysis, we assessed the overall survival impact of the quantity of followup care by category, including physician visits, imaging, and laboratory and urine tests.ResultsWe found no improvement in survival due to followup care in the perioperative and early followup periods. Receiving followup care during later followup was associated with improved survival in the low, middle and high expenditure tertiles (HR 0.23, 95% CI 0.15–0.35, HR 0.27, 95% CI 0.18–0.40 and HR 0.47, 95% CI 0.31–0.71, respectively). Instrumental variable analysis suggested that only physician visits and urine testing improved survival (HR 0.96, 0.93–0.99 and 0.95, 0.91–0.99, respectively).ConclusionsFollowup care after radical cystectomy in the later followup period was associated with improved survival. Physician visits and urine tests were associated with this improved survival. Our results suggest that aspects of followup care significantly improve patient outcomes but imaging could be done more judiciously after cystectomy.