The impact of age and comorbidity on localized pancreatic cancer outcomes: A US retrospective cohort analysis with implications for surgical centralization.
The impact of age and comorbidity on localized pancreatic cancer outcomes: A US retrospective cohort analysis with implications for surgical centralization.
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DOI：
10.1016/j.sopen.2023.02.001
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发表时间：
2023-03
影响因子：
1.4
通讯作者：
Anaya, Daniel A.
中科院分区：
文献类型：
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作者：
Powers, Benjamin D.;Allenson, Kelvin;Perone, Jennifer A.;Thompson, Zachary;Boulware, David;Denbo, Jason W.;Kim, Joon-Kyung;Permuth, Jennifer B.;Pimiento, Jose;Hodul, Pamela J.;Malafa, Mokenge P.;Kim, Dae Won;Fleming, Jason B.;Anaya, Daniel A.
年龄和合并症与胰腺癌（PDAC）的不良结局独立相关。然而，年龄和合并症对PDAC结局的影响很少被研究。本研究评估了年龄和合并症（CACI）以及手术中心容量对PDAC 90天和总生存期（OS）的影响。这项回顾性队列研究使用了2004年至2016年的国家癌症数据库，以评估切除的I/II期PDAC患者。预测变量CACI将Charlson/Deyo合并症评分与每10年生存≥50年的额外积分相结合。结果是90天死亡率和OS。该队列包括29，571例患者。90天死亡率范围从CACI 0的2%到CACI 6+患者的13%。对于CACI 0-2患者，高容量和低容量医院之间的90天死亡率差异可以忽略不计（1%）;然而，CACI 3-5（5%与9%）和CACI 6+（8%与15%）的差异更大。CACI 0-2、3-5和6+队列的总生存期分别为24.1、19.8和16.2个月。调整后的总生存期显示，CACI 0-2和3-5的高容量医院与低容量医院相比，分别有2.7和3.1个月的生存益处。然而，CACI 6+患者的OS体积没有获益。合并年龄和合并症与PDAC切除患者的短期和长期生存率相关。对于CACI高于3的患者，高容量护理的保护作用对90天死亡率更有影响。基于容量的集中政策可能对年龄较大，病情较重的患者有更大的好处。合并合并症和年龄与胰腺癌切除患者的90天死亡率和总生存率密切相关。当评估年龄和合并症对胰腺癌切除结局的影响时，在高容量中心与低容量中心治疗的年龄较大、病情较重的患者的90天死亡率高7%（8% vs. 15%），但年轻、健康患者的90天死亡率仅为1%（3% vs. 4%）。
Age and comorbidity are independently associated with worse outcomes for pancreatic adenocarcinoma (PDAC). However, the effect of combined age and comorbidity on PDAC outcomes has rarely been studied. This study assessed the impact of age and comorbidity (CACI) and surgical center volume on PDAC 90-day and overall survival (OS). This retrospective cohort study used the National Cancer Database from 2004 to 2016 to evaluate resected stage I/II PDAC patients. The predictor variable, CACI, combined the Charlson/Deyo comorbidity score with additional points for each decade lived ≥50 years. The outcomes were 90-day mortality and OS. The cohort included 29,571 patients. Ninety-day mortality ranged from 2 % for CACI 0 to 13 % for CACI 6+ patients. There was a negligible difference (1 %) in 90-day mortality between high- and low-volume hospitals for CACI 0–2 patients; however, there was greater difference for CACI 3–5 (5 % vs. 9 %) and CACI 6+ (8 % vs. 15 %). The overall survival for CACI 0–2, 3–5, and 6+ cohorts was 24.1, 19.8, and 16.2 months, respectively. Adjusted overall survival showed a 2.7 and 3.1 month survival benefit for care at high-volume vs. low-volume hospitals for CACI 0–2 and 3–5, respectively. However, there was no OS volume benefit for CACI 6+ patients. Combined age and comorbidity are associated with short- and long-term survival for resected PDAC patients. A protective effect of higher-volume care was more impactful for 90-day mortality for patients with a CACI above 3. A centralization policy based on volume may have greater benefit for older, sicker patients. Combined comorbidity and age are strongly associated with 90-day mortality and overall survival for resected pancreatic cancer patients. When assessing the impact of age and comorbidity on resected pancreatic adenocarcinoma outcomes, 90-day mortality was 7 % higher (8 % vs. 15 %) for older, sicker patients treated at high-volume vs. low-volume centers but only 1 % (3 % vs. 4 %) for younger, healthier patients.
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影响因子：
2
作者：
Conner SC;Sullivan LM;Benjamin EJ;LaValley MP;Galea S;Trinquart L
通讯作者：
Trinquart L
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
3.8
作者：
Dias-Santos, Daniela;Ferrone, Cristina R.;Fernandez-del Castillo, Carlos
通讯作者：
Fernandez-del Castillo, Carlos
影响因子：
9
作者：
Lidsky, Michael E.;Sun, Zhifei;Blazer, Dan G., III
通讯作者：
Blazer, Dan G., III
DOI：
10.2307/3348969
发表时间：
1966-01-01
期刊：
MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY
影响因子：
--
作者：
DONABEDIAN, A
通讯作者：
DONABEDIAN, A