Rectal Cancer and Teaching Hospitals: Hospital Teaching Status Affects Use of Neoadjuvant Radiation and Survival for Rectal Cancer Patients
Rectal Cancer and Teaching Hospitals: Hospital Teaching Status Affects Use of Neoadjuvant Radiation and Survival for Rectal Cancer Patients
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DOI：
10.1245/s10434-012-2769-5
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发表时间：
2013-04-01
影响因子：
3.7
通讯作者：
Wang, Li
中科院分区：
文献类型：
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作者：
Stewart, David B.;Hollenbeak, Christopher;Wang, Li
对于直肠癌，目前还不清楚如何使用放射治疗，治疗费用，以及生存率的差异，根据医院的教学designation.Private保险索赔数据与宾夕法尼亚州癌症登记处被用来确定直肠癌患者接受手术，从2004年至2006年。缺失关注数据的患者被排除。医院的特点如下：大（千分之一）与小规模（< 200张病床），教学与非教学，城市与农村。使用逻辑回归对新辅助放疗的使用进行建模，使用考克斯比例风险模型比较不同医院类型之间的癌症特异性生存率。共分析了432例患者。不同医院类型间肿瘤分期分布无差异（均P > 0.20）。与非教学机构相比，教学医院对II期和III期癌症的新辅助放疗的利用率显著较高（57%对28%; p < 0.0001）。在多变量分析中，教学状况是唯一与使用新辅助放疗相关的医院名称（p < 0.001）;医院规模和农村/城市名称不显著。非教学医院更可能使用辅助放疗治疗II期和III期疾病（13%对30%; p < 0.01）。在评估所有分期时，教学医院的直肠癌死亡率较低[风险比（HR）= 0.35; p < 0.0001]，住院治疗费用相似（教学：30，769美元，非教学：26，892美元; p = 0.22）。教学指定与II期和III期疾病的新辅助放疗发生率较高相关，与非教学医院相比，癌症特异性生存率提高，治疗费用相似。
For rectal cancer, it is unknown how use of radiation, treatment cost, and survival differ based on hospital teaching designation.Private insurance claims data linked with the Pennsylvania Cancer Registry were used to identify rectal cancer patients undergoing surgery from 2004 to 2006. Patients with missing data of interest were excluded. Hospitals were characterized as follows: large (a parts per thousand yen200 beds) versus small size (< 200 beds), teaching versus nonteaching, and urban versus rural. Logistic regression was used to model the use of neoadjuvant radiotherapy, and Cox proportional hazards models were used to compare cancer-specific survival between hospital types.A total of 432 patients were analyzed. There was no difference in the distribution of cancer stages among the various hospital types (all p > 0.20). Teaching hospitals were associated with significantly higher utilization of neoadjuvant radiotherapy for stage II and III cancers compared with nonteaching facilities (57 vs. 28 %; p < 0.0001). On multivariate analysis, teaching status was the only hospital designation associated with use of neoadjuvant radiation (p < 0.001); hospital size and rural/urban designation were not significant. Nonteaching hospitals were more likely to use adjuvant radiotherapy for stage II and III disease (13 vs. 30 %; p < 0.01). Teaching hospitals had lower odds of death from rectal cancer when evaluating all stages [hazard ratio (HR) = 0.35; p < 0.0001] with similar costs of inpatient treatment (teaching: US $30,769 versus nonteaching: US $26,892; p = 0.22).Teaching designation was associated with higher incidence of neoadjuvant radiotherapy for stage II and III disease, with improved cancer-specific survival compared with nonteaching hospitals, and with similar treatment costs.