Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system
Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system
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DOI：
10.1016/j.amjsurg.2014.07.001
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发表时间：
2015-02-01
影响因子：
3
通讯作者：
Chung, Mathew H.
中科院分区：
文献类型：
--
作者：
Wright, Gerald Paul;Mater, Megan E.;Chung, Mathew H.
背景：美国外科医生学会肿瘤组Z 0011试验被誉为实践的改变。我们试图确定其对乳腺癌手术的影响，在社区hospitalsetting.METHODS：一项回顾性研究进行了8个社区医院确定符合Z 0011标准的浸润性乳腺癌患者。主要结果指标为腋窝淋巴结清扫术（ALND）完成率和术中前哨淋巴结（SLN）分析随时间推移的表现。结果：共有1,125例肿块切除术和SLN活检，其中180例符合纳入标准。ALND（P <0.0001）和术中SLN分析（P <0.0001）的性能在每个时间段都有所下降。更可能接受ALND的患者包括囊外扩张的患者（比值比[OR] 12.8，95%置信区间[CI] 2.5 - 67.1）和接受再次手术的患者（OR 10.8，95% CI 2.6 - 44.4）或术中SLN分析结论：美国外科医师学会肿瘤组Z 0011试验在社区医院环境中的实践变化迅速。(C)2015 Elsevier Inc. All rights reserved.
BACKGROUND: The American College of Surgeons Oncology Group Z0011 trial has been lauded as practice changing. We sought to identify its impact on breast cancer surgery in the community hospital setting.METHODS: A retrospective review was performed from 8 community hospitals identifying patients with invasive breast cancer meeting the Z0011 criteria. The primary outcome measures were the rate of completion axillary lymph node dissection (ALND) and performance of intraoperative sentinel lymph node (SLN) analysis over time.RESULTS: A total of 1,125 lumpectomies with SLN biopsies were performed with 180 subjects meeting inclusion criteria. Performance of ALND (P < .0001) and intraoperative SLN analysis (P < .0001) declined during each time period. Patients more likely to undergo ALND included those with extracapsular extension (odds ratio [OR] 12.8, 95% confidence interval [CI] 2.5 to 67.1) and those who underwent reoperative surgery (OR 10.8, 95% CI 2.6 to 44.4) or intraoperative SLN analysis (OR 5.1, 95% CI 1.2 to 21.9).CONCLUSION: American College of Surgeons Oncology Group Z0011 trial has been rapidly practice changing in the community hospital setting. (C) 2015 Elsevier Inc. All rights reserved.