National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery
National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery
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DOI：
10.1245/s10434-013-3338-2
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发表时间：
2014-04-01
影响因子：
3.7
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Merkow, Ryan P.;Bilimoria, Karl Y.;Pawlik, Timothy M.
背景手术切缘受累是胰腺癌手术后的一个重要结局;然而，病理审查实践的变化可能会限制其作为质量指标的使用。我们的目的是评估医院绩效的变化和胰腺癌手术后切缘受累的可靠性。从国家癌症数据库中，确定了因I至III期腺癌接受胰腺切除术的患者。风险调整后的手术切缘受累采用分层回归方法进行评估，并确定医院绩效和可靠性的变化。在1，002家医院中，14，889例患者因腺癌接受胰腺切除术，3，573例（24.0%）手术切缘受累（R1 22.8%; R2 1.2%）。与切缘受累相关的最强预测因子是T分期[T3：比值比（OR）2.08，95%置信区间（CI）1.68-2.59; T4：OR 7.26，95% CI 5.50-9.60; vs. T1]和肿瘤大小（2-3.9 cm：OR 1.66，95% CI 1.39-1.98，>= 4 cm：OR 2.28，95% CI 1.90-2.74;对比< 2 cm）。与切缘受累可能性降低相关的因素是新辅助治疗的使用和医院类型（学术和国家癌症研究所指定的综合癌症中心与社区）。在医院层面，平均风险调整后的手术切缘受累率为25.9%，范围为10.1%至50.5%。21家（2.1%）医院的切缘受累低于预期，17家（1.7%）医院的切缘受累高于预期。在13例病例中，249家医院进行了79%的胰腺切除术评估，达到了0.4的最低可接受可靠性。尽管病理评估实践存在差异，但医院可以提供可行且可靠的胰腺癌切除术后手术切缘状态的比较数据。
Background. Surgical margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of margin involvement after pancreatic cancer surgery.Methods. From the National Cancer Data Base, patients who underwent pancreatic resection for stage I to III adenocarcinoma were identified. Risk-adjusted surgical margin involvement was evaluated using hierarchical regression methods, and variation in hospital performance and reliability was determined.Results. From 1,002 hospitals, 14,889 patients underwent pancreatic resection for adenocarcinoma, and 3,573 (24.0 %) had an involved surgical margin (R1 22.8 %; R2 1.2 %). The strongest predictors associated with margin involvement were T stage [T3: odds ratio (OR) 2.08, 95 % confidence interval (CI) 1.68-2.59; T4: OR 7.26, 95 % CI 5.50-9.60; vs. T1] and tumor size (2-3.9 cm: OR 1.66, 95 % CI 1.39-1.98, >= 4 cm: OR 2.28, 95 % CI 1.90-2.74; vs. < 2 cm). Factors associated with a decreased likelihood of margin involvement were the use of neoadjuvant therapy and hospital type (academic and National Cancer Institute designated comprehensive cancer centers vs. community). At the hospital level, the mean risk-adjusted surgical margin involvement rate was 25.9 % and ranged 10.1 to 50.5 %. Twenty-one (2.1 %) hospitals had lower-than-expected and 17 (1.7 %) had higher-than-expected margin involvement. A minimum acceptable reliability of 0.4 was met after 13 cases and was achieved by 249 hospitals that performed 79 % of pancreatic resections assessed.Conclusions. Despite differences in pathologic evaluation practices, hospitals can be feasibly and reliably provided comparative data on surgical margin status after resection for pancreatic cancer.