Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer
Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer
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DOI：
10.1001/archsurg.143.7.671
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发表时间：
2008-07-01
影响因子：
--
通讯作者：
Bentrem, David J.
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文献类型：
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作者：
Bilimoria, Karl Y.;Talamonti, Mark S.;Bentrem, David J.
假设：对于胃癌和胰腺癌，区域淋巴结评估对于患者疾病的准确分期非常重要，并且可能与提高生存率相关。我们假设国家综合癌症网络（NCCN）、国家癌症研究所（NCI）指定的机构和高容量医院比低容量中心和社区医院检查更多的胃和胰腺恶性肿瘤淋巴结。设计：容量-结果研究。设置：学术研究。患者：使用国家癌症数据库（2003年1月1日至2004年12月31日），确定了接受胃切除术的患者（n = 3088）和胰腺（n = 1130 [仅胰腺切除术]）癌症。主要结果测量：多变量逻辑回归分析被用来评估医院类型和容量对淋巴结评估的影响结果：在美国，只有23.2%的胃癌患者和16.4%的胰腺癌患者接受了至少15个淋巴结的评估。接受手术的患者在NCCN-NCI医院检查的淋巴结比在社区医院检查的淋巴结多（胃癌中位数为12比6，胰腺癌中位数为9比6; P <0.001）。高容量医院的患者比低容量医院的患者检查更多的淋巴结（胃癌中位数为10比6，胰腺癌中位数为8比6; P < .001）。在多变量分析中，与在社区医院和低容量中心接受手术的患者相比，在NCCN-NCI和高容量医院接受手术的患者更可能有至少15个淋巴结评估（分别为P <0.001和P = 0.02）。结论：淋巴结检查对于分期、辅助治疗决策和临床试验分层很重要。此外，淋巴结评估的差异可能有助于改善NCCN-NCI中心和高容量医院胃癌和胰腺癌患者的长期预后。
Hypothesis: For gastric and pancreatic cancer, regional lymph node evaluation is important to accurately stage disease in a patient and may be associated with improved survival. We hypothesized that National Comprehensive Cancer Network (NCCN), National Cancer Institute (NCI)-designated institutions, and high-volume hospitals examine more lymph nodes for gastric and pancreatic malignant neoplasms than do low-volume centers and community hospitals.Design: Volume-outcome study.Setting: Academic research.Patients: Using the National Cancer Data Base (January 1, 2003, to December 31, 2004), patients were identified who underwent resection for gastric (n = 3088) and pancreatic (n = 1130 [pancreaticoduodenectomy only]) cancer.Main Outcome Measures: Multivariable logistic regression analysis was used to assess the effect of hospital type and volume on nodal evaluation (>= 15 nodes).Results: Only 23.2% of patients with gastric cancer and 16.4% of patients with pancreatic cancer in the United States underwent evaluation of at least 15 lymph nodes. Patients undergoing surgery had more lymph nodes examined at NCCN-NCI hospitals than at community hospitals (median, 12 vs 6 for gastric cancer and 9 vs 6 for pancreatic cancer; P < .001). Patients at highest-volume hospitals had more lymph nodes examined than patients at low-volume hospitals (median, 10 vs 6 for gastric cancer and 8 vs 6 for pancreatic cancer; P < .001). On multivariable analysis, patients undergoing surgery at NCCN-NCI and high-volume hospitals were more likely to have at least 15 lymph nodes evaluated compared with patients undergoing surgery at community hospitals and low-volume centers (P < .001 and P = .02, respectively).Conclusions: Nodal examination is important for staging, adjuvant therapy decision making, and clinical trial stratification. Moreover, differences in nodal evaluation may contribute to improved long-term outcomes at NCCN-NCI centers and high-volume hospitals for patients with gastric and pancreatic cancer.