Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma.
Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma.
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DOI：
10.1016/j.jmig.2021.07.018
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发表时间：
2022-03
影响因子：
4.1
通讯作者：
Felix AS
中科院分区：
文献类型：
--
作者：
Bixel K;Barrington DA;Vetter MH;Suarez AA;Felix AS
探讨子宫内膜癌（EC）患者手术方式的决定因素以及手术方式与总生存率（OS）之间的关系。回顾性队列。国家癌症数据库（NCDB），2010-2015年。140，470例组织学确诊的EC患者接受了子宫切除术。根据手术入路对患者进行分组。纳入了140，470例EC患者。机器人辅助腹腔镜（RAL）是最常见的手术方法（48.8%），其次是剖腹手术（33.6%）和传统腹腔镜（17.6%）。在研究期间，RAL的使用有所增加，而剖腹手术治疗的病例百分比有所下降。老年妇女，那些有保险的人，居住在邮政编码较低的人没有高中毕业的比例，以及那些在非社区癌症项目中接受治疗的人与RAL相比不太可能接受剖腹手术，而非白人妇女，那些诊断为高级组织学的人，和晚期更有可能接受剖腹手术与RAL相比。与RAL相比，所有其他手术入路的OS较差（剖腹手术：HR 1.21，95% CI 1.18-1.25，传统腹腔镜：HR 1.06，95% CI 1.02-1.10）。根据年龄、种族、组织学、分期和辅助治疗，观察到手术入路和OS关系的显著效果改变。RAL在研究期间的频率增加，并与OS改善相关，支持继续使用RAL进行EC管理。机器人辅助腹腔镜手术治疗子宫内膜癌与提高生存率相关，手术方法对年轻女性和低级别子宫内膜样癌组织的影响最大。
To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). Retrospective cohort. The National Cancer Database (NCDB), 2010–2015. 140,470 patients with histologically confirmed EC who underwent hysterectomy. Patients were grouped according to surgical approach. 140,470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%) followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, while percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in zip codes with lower proportions of individuals who did not graduate from high school, and those treated at non-community cancer programs were less likely to undergo laparotomy compared to RAL, while non-White women, those diagnosed with high-grade histology, and advanced stage were more likely to undergo laparotomy vs. RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: HR 1.21, 95% CI 1.18–1.25, traditional laparoscopy: HR 1.06, 95% CI 1.02–1.10). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed. RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management. Robotic assisted laparoscopy for endometrial cancer is associated with improved survival and the greatest impact of surgical approach was noted for young women and low-grade endometrioid histology.
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影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
4.7
作者：
Kilgore, Joshua E.;Jackson, Amanda L.;Boggess, John F.
通讯作者：
Boggess, John F.
影响因子：
4.7
作者：
Lavoue, Vincent;Zeng, Xing;Gotlieb, Walter H.
通讯作者：
Gotlieb, Walter H.
DOI：
10.1016/j.jamcollsurg.2011.12.024
发表时间：
2012-04-01
影响因子：
5.2
作者：
Parsons, Helen M.;Habermann, Elizabeth B.;Al-Refaie, Waddah B.
通讯作者：
Al-Refaie, Waddah B.
影响因子：
9.8
作者：
Stephan, Jean-Marie;Goodheart, Michael J.;Bender, David
通讯作者：
Bender, David