Impact of Treatment Coordination on Overall Survival in Rectal Cancer.
Impact of Treatment Coordination on Overall Survival in Rectal Cancer.
复制标题
DOI：
10.1016/j.clcc.2021.01.002
复制
发表时间：
2021-09
影响因子：
3.4
通讯作者：
Rajput A
中科院分区：
文献类型：
--
作者：
Biju K;Zhang GQ;Stem M;Sahyoun R;Safar B;Atallah C;Efron JE;Rajput A
直肠癌的治疗通常是多模式的，包括手术、化疗和放射治疗。然而，这些模式之间协调的影响目前尚不清楚。我们的目的是评估在与手术相同的设施内进行非手术治疗是否会影响直肠癌患者的生存。对2004年至2016年期间从国家癌症数据库中接受多模式治疗的II-IV期直肠癌患者进行了回顾分析。将患者分为三组：A组手术+化疗+放疗(手术+2)；B)手术+化疗或放射治疗(手术+1)；C)仅在报告设施进行手术(化疗+放疗)(手术+0)。主要结果是5年总生存率(OS)，使用Kaplan-Meier曲线、对数等级检验和Cox比例风险模型进行分析。共纳入44,716例患者(16,985例(37.98%)手术+2，12,317例(27.54%)手术+1，15,414例(34.47%)手术+0)。在单变量分析中，我们观察到，与手术+1或手术+0患者相比，手术+2患者的5年OS显著高于手术+1或手术+0患者(5年OS：63.46%比62.50%比61.41%；p=0.002)。我们在多变量COX比例风险分析中观察到了类似的结果，与手术+2组相比，手术+0组的死亡率增加(HR：1.09p<；0.001)。在第二阶段(HR1.10；p=0.022)和第三阶段(HR1.12；p<；0.001)按阶段分层后，这些结果仍然成立，但对于第四阶段(p=0.474)则不是这样。同一机构内护理协调程度越高，II-III期直肠癌患者的OS越大。这一发现说明了跨学科协作在多模式直肠癌治疗中的重要性。治疗协调对直肠癌预后的影响还不是很清楚。在这个国家癌症数据库对一位直肠癌II至IV期患者队列(n=44,716)的回顾分析中，我们发现更多的护理协调程度与更好的总体生存相关。这突显了直肠癌治疗中专科团队之间沟通的重要性。
Rectal cancer treatment is often multimodal, comprising of surgery, chemotherapy, and radiotherapy. However, the impact of coordination between these modalities is currently unknown. We aimed to assess whether delivery of non-surgical therapy within same facility as surgery impacts survival in patients with rectal cancer. A patient cohort with rectal cancer stages II-IV who received multimodal treatment between 2004 and 2016 from National Cancer Database was retrospectively analyzed. Patients were categorized into three groups: A) surgery+chemotherapy+radiotherapy at same facility (surgery+2); B) surgery+chemotherapy or radiotherapy at same facility (surgery+1); or C) only surgery at reporting facility (chemotherapy+radiotherapy elsewhere) (surgery+0). The primary outcome was 5-year overall survival (OS), analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazard models. A total of 44,716 patients (16,985 [37.98%] surgery+2, 12,317 [27.54%] surgery+1, and 15,414 [34.47%] surgery+0) were included. In univariate analysis, we observed that surgery+2 patients had significantly greater 5-year OS compared to surgery+1 or surgery+0 patients (5-year OS: 63.46% vs. 62.50% vs. 61.41%, respectively; p=0.002). We observed similar results in multivariable Cox proportional-hazards analysis, with surgery+0 group demonstrating increased hazard of mortality when compared to surgery+2 group (HR: 1.09; p<0.001). These results held true after stratification by stage for stage II (HR 1.10; p=0.022) and stage III (HR 1.12; p<0.001) but not for stage IV (p=0.474). Greater degree of care coordination within the same facility is associated with greater OS in patients with stage II-III rectal cancer. This finding illustrates the importance of interdisciplinary collaboration in multimodal rectal cancer therapy. The impact of treatment coordination on outcome in rectal cancer is not well understood. In this National Cancer Database retrospective analysis of a patient cohort (n=44,716) with rectal cancer stages II to IV, we found that greater degree of care coordination is associated with better overall survival. This highlights the importance of communication between specialty teams in rectal cancer management.
登录
查看更多内容
DOI：
10.1002/hed.25697
发表时间：
2019-07-01
影响因子：
2.9
作者：
Amini, Arya;Stokes, William A.;Karam, Sana D.
通讯作者：
Karam, Sana D.
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：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
158.5
作者：
Kapiteijn, E;Marijnen, CAM;van de Velde, CJH
通讯作者：
van de Velde, CJH
影响因子：
9
作者：
Fong, Y;Fortner, J;Blumgart, LH
通讯作者：
Blumgart, LH