Effectiveness of Implemented Interventions on Pathologic Nodal Staging of Non-Small Cell Lung Cancer.
Effectiveness of Implemented Interventions on Pathologic Nodal Staging of Non-Small Cell Lung Cancer.
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实施干预措施对非小细胞肺癌病理结节分期的效果。
DOI：
10.1016/j.athoracsur.2018.02.021
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Osarogiagbon RU
中科院分区：
文献类型：
--
作者：
Ray MA;Faris NR;Smeltzer MP;Fehnel C;Houston-Harris C;Levy P;Wiggins L;Sachdev V;Robbins T;Spencer D;Osarogiagbon RU
准确的病理淋巴结分期可提高早期非小细胞肺癌的生存率。在一项正在进行的实施研究中，我们评估了一种手术淋巴结标本采集工具包以及一种更彻底的病理大体解剖方法对达到指南推荐的病理淋巴结分期质量的影响。
我们前瞻性地收集了2009年至2016年来自达特茅斯医院连续4个转诊区域的11家医院的以根治为目的的非小细胞肺癌切除术的数据。在我们交错实施的研究设计中，根据对两种干预措施的接触情况，我们将患者分为4组。我们使用卡方检验来检查不同实施组在人口统计学和疾病特征以及手术质量标准方面的差异。
在2469名患者中，1615名（65%）未接受任何干预；167名（7%）仅接受了病理干预；264名（11%）仅接受了手术干预；423名（17%）两者都接受了。淋巴结未检查率按照无干预、新解剖方法、工具包以及联合干预的顺序依次降低，包括未检查任何淋巴结、肺门/肺内淋巴结和纵隔淋巴结（所有比较均p<0.001）。达到美国国家综合癌症网络、美国癌症委员会、美国癌症联合委员会以及美国外科医师学会肿瘤学组指南的比率按照相同的顺序显著增加（所有比较均p<0.001）。
两种干预措施相结合以改善病理淋巴结检查，相较于单独使用任何一种干预措施，对达到一系列手术质量标准具有更大的影响。
Accurate pathologic nodal staging improves early-stage non-small-cell lung cancer survival. In an ongoing implementation study, we measured the impact of a surgical lymph node specimen collection kit and a more thorough pathologic gross dissection method, on attainment of guideline-recommended pathologic nodal staging quality. We prospectively collected data on curative-intent non-small cell lung cancer resections from 2009–2016 from 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions. We categorized patients into 4 groups based on exposure to the two interventions in our staggered implementation study design. We used Chi-squared tests to examine the differences in demographic and disease characteristics and surgical quality criteria across implementation groups. Of 2,469 patients, 1,615 (65%) received neither intervention; 167 (7%) received only the pathology intervention; 264 (11%) received only the surgery intervention; 423 (17%) had both. Rates of non-examination of lymph nodes reduced sequentially in the order of no intervention, novel dissection, kit, and combined interventions, including non-examination of: any lymph nodes, hilar/intrapulmonary and mediastinal nodes (p<0.001 for all comparisons). The rates of attainment of National Comprehensive Cancer Network, Commission on Cancer, American Joint Committee on Cancer, and American College of Surgeons Oncology Group guidelines increased significantly in the same sequential order (p<0.001 for all comparisons). The combined effect of two interventions to improve pathologic lymph node examination has a greater effect on attainment of a range of surgical quality criteria than either intervention alone.
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影响因子：
20.4
作者：
Osarogiagbon, Raymond U.;Yu, Xinhua
通讯作者：
Yu, Xinhua
淋巴结的数量与病理淋巴结非小细胞肺癌中长期死亡率风险最大相关的淋巴结数量。
影响因子：
4.6
作者：
Osarogiagbon, Raymond U.;Ogbata, Obiageli;Yu, Xinhua
通讯作者：
Yu, Xinhua
影响因子：
4.6
作者：
Samson, Pamela;Crabtree, Traves;Broderick, Stephen;Kreisel, Daniel;Krupnick, A. Sasha;Patterson, G. Alexander;Meyers, Bryan;Puri, Varun
通讯作者：
Puri, Varun
影响因子：
4.6
作者：
Osarogiagbon, Raymond U.;Ray, Meredith A.;Robbins, Edward T.
通讯作者：
Robbins, Edward T.
影响因子：
2
作者：
Osarogiagbon, Raymond U.;Eke, Ransome;Sareen, Srishti;Leary, Cynthia;Coleman, LaShundra;Faris, Nicholas;Yu, Xinhua;Spencer, David
通讯作者：
Spencer, David