Frequency of Use and Predictors of Cancer-Directed Surgery in the Management of Malignant Pleural Mesothelioma in a Community-Based (Surveillance, Epidemiology, and End Results [SEER]) Population
Frequency of Use and Predictors of Cancer-Directed Surgery in the Management of Malignant Pleural Mesothelioma in a Community-Based (Surveillance, Epidemiology, and End Results [SEER]) Population
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DOI：
10.1097/jto.0b013e3181f1903e
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发表时间：
2010-10-01
影响因子：
20.4
通讯作者：
Pass, Harvey I.
中科院分区：
文献类型：
--
作者：
Flores, Raja M.;Riedel, Elyn;Pass, Harvey I.
介绍：在专科三级医院治疗的间皮瘤患者的手术干预率远远超过42%。间皮瘤手术策略在社会上是不太明确的。本研究评估了使用频率和预测的癌症定向手术干预在nontertiary-based人口和预测因素为surgery intervention.Methods：监测，流行病学和最终结果数据库进行了检索，从1990年至2004年。分析的变量包括年龄、性别、种族、诊断年份、地区、生命状态、分期、手术和不手术的原因。采用卡方检验和逻辑回归分析评价接受癌症定向手术的患者变量之间的相关性。间皮瘤的发病率也进行了评估，在此期间的time.Results：病理证实的恶性胸膜间皮瘤被确定在1166名妇女和4771名男子。癌症定向手术率为22%（n = 1317）。接受癌症导向手术的重要预测因素包括种族、年龄和分期（所有p < 0.0001）。在调整患者和疾病特征后，对癌症导向手术对生存率的影响进行了里程碑式分析，结果显示风险比为0.68（p < 0.0001）。恶性胸膜间皮瘤的发病率一直保持constant.Conclusions：在社区手术干预率低于三级转诊中心。年龄、分期和种族可以预测接受癌症导向手术的可能性。在黑人患者中观察到较低的癌症定向手术率和较差的总体结局。作为质量保证的一部分，应考虑将患者转诊至具有多学科项目（包括胸外科专业知识）的中心。
Introduction: Surgical intervention rates for mesothelioma patients treated at specialized tertiary hospitals are well more than 42%. Mesothelioma surgical strategies in the community are less well defined. This study evaluates the frequency of use and predictors of cancer-directed surgical intervention in a nontertiary-based population and the predictors for surgical intervention.Methods: The Surveillance, Epidemiology, and End Results database was searched from 1990 to 2004. Variables analyzed included age, sex, race, year of diagnosis, region, vital status, stage, surgery, and reasons for no surgery. The association of patient variables on receipt of cancer-directed surgery was evaluated using chi(2) tests and logistic regression. The incidence of mesothelioma was also evaluated over this period of time.Results: Pathologically proven malignant pleural mesothelioma was identified in 1166 women and 4771 men. The rate of cancer-directed surgery was 22% (n = 1317). Significant predictors of receiving cancer-directed surgery included race, age, and stage (all p < 0.0001). A landmark analysis on the effect of cancer-directed surgery on survival after adjusting for patient and disease characteristics demonstrated a hazard ratio of 0.68 (p < 0.0001). The incidence rate of malignant pleural mesothelioma has remained constant.Conclusions: The rate of surgical intervention in the community is lower compared with tertiary referral centers. Age, stage, and race predict the likelihood of receiving cancer-directed surgery. A lower rate of cancer-directed surgery and worse overall outcome were observed in black patients. As part of quality assurance, referral of patients to centers with multidisciplinary programs that include thoracic surgical expertise should be considered.