Surgical Complications Are Associated With Omission of Chemotherapy for Stage III Colorectal Cancer
Surgical Complications Are Associated With Omission of Chemotherapy for Stage III Colorectal Cancer
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DOI：
10.1007/dcr.0b013e3181f2f202
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发表时间：
2010-12-01
影响因子：
3.9
通讯作者：
Morris, Arden M.
中科院分区：
文献类型：
--
作者：
Hendren, Samantha;Birkmeyer, John D.;Morris, Arden M.
目的：适当使用辅助化疗是广泛认可的结直肠癌护理质量措施。本研究的目的是检验手术并发症与结直肠癌省略化疗相关的假设。 方法：我们使用 1998 年至 2005 年的监测、流行病学和最终结果 - 医疗保险数据库来研究接受手术切除的 III 期结直肠癌患者的辅助化疗使用情况。比较有和没有并发症的患者的化疗使用情况。使用单变量分析和多元逻辑回归来测试并发症与化疗省略之间的关联，同时调整人口统计、合并症和其他因素。还研究了并发症与化疗时间之间的关联。结果：我们确定了 17,108 名符合条件的 III 期结直肠癌患者（中位年龄 75 岁；24% 为直肠癌/直肠乙状结肠癌）。使用简单的并发症代码列表，18% 的患者有 >= 1 种并发症。 13% 的患者出现医疗并发症，3.8% 的患者出现需要再次手术或其他手术的并发症。 46% 的出现并发症的患者省略了辅助化疗，而无并发症的患者中这一比例为 31% (P < .0001)。在多变量分析中，出现并发症与省略化疗独立相关（调整后 OR，1.76；95% CI 1.59-1.95）。与化疗遗漏显着相关的其他因素包括年龄、种族、婚姻状况、紧急/紧急入院和手术类型。多种并发症的风险比增加 (P < .0001)。并发症还与化疗延迟风险增加相关 (P < .0001)。结论：手术并发症与 III 期结直肠癌化疗的省略和辅助化疗的延迟独立相关。这些数据表明结直肠手术的并发症可能会影响短期和长期的癌症结果。因此，实施有效减少围手术期并发症的质量改进措施也可能提供长期的癌症生存获益。
PURPOSE: Appropriate use of adjuvant chemotherapy is a widely recognized quality measure of colorectal cancer care. The objective of this study was to test the hypothesis that surgical complications are associated with omission of chemotherapy for colorectal cancer.METHODS: We used the 1998 to 2005 Surveillance, Epidemiology and End Results-Medicare database to study adjuvant chemotherapy use among patients with stage III colorectal cancer who underwent surgical resection. Chemotherapy use was compared between patients with and without complications. Univariate analyses and multiple logistic regression were used to test the association between complications and chemotherapy omission, while adjusting for demographics, comorbidity, and other factors. Associations between complications and time to chemotherapy were also studied.RESULTS: We identified 17,108 eligible patients with stage III colorectal cancer (median age, 75 y; 24% rectal/rectosigmoid). Using a parsimonious list of complication codes, 18% of patients had >= 1 complication. Thirteen percent of patients had medical complications and 3.8% of patients had complications requiring reoperation or another procedure. Adjuvant chemotherapy was omitted among 46% of patients with complications, compared with 31% of patients with no complications (P < .0001). Having a complication was independently associated with omission of chemotherapy in multivariable analysis (adjusted OR, 1.76; 95% CI 1.59-1.95). Other factors significantly associated with chemotherapy omission were age, race, marital status, urgent/emergent admission, and type of operation. Risk ratios increase with multiple complications (P < .0001). Complications were also associated with an increased risk of chemotherapy delay (P < .0001).CONCLUSIONS: Surgical complications are independently associated with omission of chemotherapy for stage III colorectal cancer and with a delay in adjuvant chemotherapy. These data suggest that complications of colorectal surgery may affect both short-and long-term cancer outcomes. Thus, the implementation of quality improvement measures that effectively reduce perioperative complications may also provide a long-term cancer survival benefit.