Multispecialist Care and Mortality in Hepatocellular Carcinoma
Multispecialist Care and Mortality in Hepatocellular Carcinoma
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DOI：
10.1097/coc.0000000000000000
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发表时间：
2015-12-01
影响因子：
2.6
通讯作者：
Shaya, Fadia T.
中科院分区：
文献类型：
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作者：
Chirikov, Viktor V.;Mullins, C. Daniel;Shaya, Fadia T.
目的：多学科的医生护理已经增加了许多癌症，但很少有证据存在肝细胞癌（HCC）。本研究的目的是探讨多专科护理和死亡率之间的关联在HCC. Methods：治疗患者与HCC的初步诊断，从2000年至2007年进行了研究，使用监测，流行病学和最终结果医疗保险数据。多学科治疗的替代变量定义为治疗前阶段外科医生、放射肿瘤学家、介入放射学家、血液学家/内科肿瘤学家、胃肠病学家和全科医生的学科数量。进行多变量生存分析，并调整选择和生存bias.Results：3588治疗肝癌患者，1434（40%）看到1，1343（37%）看到2，811（23%）看到3个或更多的专家。接受多专家护理的患者接受的治疗与接受单一专家治疗的患者不同。在倾向评分调整的生存分析中，与看1个专家的患者相比，看3个或更多专家类型的患者死亡率降低10%（P = 0.04）。当分层接受治疗，化疗的患者谁看到3个或更多的专家类型与28%（P = 0.002）降低死亡率相比，那些谁看到1 specialist.Conclusions：多专科治疗肝癌患者与死亡率降低，特别是在化疗受者。虽然调整了选择和生存偏倚，但我们的研究在捕获协调的多学科护理与死亡率之间的因果关系方面有限。我们的研究结果可能为协调护理提供模式的发展提供支持，但应在未来的研究中通过更严格的检查来证实。
Purpose:Multidisciplinary physician care has increased for many cancers yet little evidence exists for hepatocellular carcinoma (HCC). The purpose of this study was to explore the association between multispecialist care and mortality in HCC.Methods:Treated patients with an HCC primary diagnosis from 2000 to 2007 were studied using Surveillance, Epidemiology, and End Results-Medicare data. A surrogate variable for multidisciplinary care was definedmultispecialist careas the number of disciplines among surgeons, radiology oncologist, intervention radiologist, hematologist/medical oncologist, gastroenterologist, and generalist in the pretreatment period. Multivariate survival analysis was conducted and adjusted for selection and survival bias.Results:Of 3588 treated HCC patients, 1434 (40%) saw 1, 1343 (37%) saw 2, and 811 (23%) saw 3 or more specialists. Patients with multispecialist care received treatment that differed from patients who saw a single specialist. In propensity score-adjusted survival analysis, patients who saw 3 or more specialist types were associated with 10% (P=0.04) reduced mortality, compared with those who saw 1 specialist. When stratified by treatment received, patients on chemotherapy who saw 3 or more specialist types were associated with 28% (P=0.002) reduced mortality, compared with those who saw 1 specialist.Conclusions:Multispecialist care for treated HCC patients was associated with reduced mortality, particularly among chemotherapy recipients. While adjusting for selection and survival bias, our study is limited in capturing a causal relationship between coordinated multidisciplinary care and mortality. Our findings may provide support for the development of coordinated care delivery models but should be confirmed through more rigorous examination in future studies.