Clinical and Economic Evaluation of Treatment Strategies for T1N0 Anal Canal Cancer.
Clinical and Economic Evaluation of Treatment Strategies for T1N0 Anal Canal Cancer.
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T1N0 肛管癌治疗策略的临床和经济评估。
DOI：
10.1097/coc.0000000000000339
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Cantor,ScottB
中科院分区：
文献类型：
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作者：
Deshmukh,AshishA;Zhao,Hui;Das,Prajnan;Chiao,ElizabethY;You,Yi-QianNancy;Franzini,Luisa;Lairson,DavidR;Swartz,MichaelD;Giordano,SharonH;Cantor,ScottB
目的：尚未对T1N0肛管癌的治疗方案进行比较评价。我们比较了T1N0肛管癌的治疗方案——放化疗（CRT）、放疗（RT）和手术或消融技术（手术/消融）的相关结果。材料和方法：本回顾性队列研究使用与联邦医疗保险纵向数据（SEER-Medicare数据库）相关的监测、流行病学和最终结果（SEER）注册中心进行。分析包括190例接受T1N0肛管癌手术/消融治疗的患者（n= 44）， RT （n= 50）或CRT （n= 96）。结果分别采用Kaplan-Meier和Cox比例风险模型，以生存率和风险比进行报道；一生的成本;成本效益是用增量成本效益比来衡量的，也就是两种选择之间的成本差异与相同两种选择之间的效率差异之比。结果：Kaplan-Meier曲线预测两组患者的生存时间无显著差异。调整患者特征和倾向评分后，与手术/消融相比，接受CRT的患者死亡风险比为1.742(95%可信区间，0.793-3.829)，RT为2.170(95%可信区间，0.923-5.101)；然而，这种关系没有达到统计学意义。手术/消融术的终生成本低于RT或CRT。与手术/消融相比，与CRT相关的增量成本-效果比为每生命年增加142,883美元。结论：T1N0肛管癌不同治疗方案的生存率无统计学差异。鉴于手术/消融费用低于RT或CRT，并且与RT和CRT相比可能具有成本效益，因此在医疗资源有限的时代进一步探索这一发现至关重要。
Objective:A comparative assessment of treatment alternatives for T1N0 anal canal cancer has never been conducted. We compared the outcomes associated with the treatment alternatives—chemoradiotherapy (CRT), radiotherapy (RT), and surgery or ablation techniques (surgery/ablation)—for T1N0 anal canal cancer.Materials and Methods:This retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER) registries linked with Medicare longitudinal data (SEER-Medicare database). Analysis included 190 patients who were treated for T1N0 anal canal cancer using surgery/ablation (n= 44), RT (n= 50), or CRT (n= 96). The outcomes were reported in terms of survival and hazards ratios using Kaplan-Meier and Cox proportional hazards modeling, respectively; lifetime costs; and cost-effectiveness measured in terms of incremental cost-effectiveness ratio, that is, the ratio of the difference in costs between the 2 alternatives to the difference in effectiveness between the same 2 alternatives.Results:There was no significant difference in the survival duration between the treatment groups as predicted by the Kaplan-Meier curves. After adjusting for patient characteristics and propensity score, the hazard ratio of death for the patients who received CRT compared with surgery/ablation was 1.742 (95% confidence interval, 0.793-3.829) and RT was 2.170 (95% confidence interval, 0.923-5.101); however, the relationship did not reach statistical significance. Surgery/ablation resulted in lower lifetime cost than RT or CRT. The incremental cost-effectiveness ratio associated with CRT compared with surgery/ablation was $142,883 per life year gained.Conclusions:There was no statistically significant difference in survival among the treatment alternatives for T1N0 anal canal cancer. Given that surgery/ablation costs less than RT or CRT and might be cost-effective compared with RT and CRT, it is crucial to explore this finding further in this era of limited health care resources.