Patient Survival After Surgical Treatment of Rectal Cancer Impact of Surgeon and Hospital Characteristics
Patient Survival After Surgical Treatment of Rectal Cancer Impact of Surgeon and Hospital Characteristics
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DOI：
10.1002/cncr.28746
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发表时间：
2014-08-15
期刊：
影响因子：
6.2
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
--
作者：
Etzioni, David A.;Young-Fadok, Tonia M.;Habermann, Elizabeth B.
背景：外科医生和医院因素与直肠癌患者的生存率相关。这些因素对决定结果的相对贡献，人们了解得很少。方法：我们使用来自监测、流行病学和最终结果-医疗保险数据库的数据来分析1998年至2007年间在美国诊断的65岁及以上接受手术治疗的非转移性直肠癌患者的结果。这些数据与注册表相关联，以确定治疗外科医生是否为经委员会认证的结直肠外科医生，而非结直肠外科医生。同时还分析了作为国家癌症研究所指定的综合癌症中心的医院数量和医院认证。主要关注的结局是长期生存。结果：我们的数据来源产生了6432例患者。初步分析表明，在规模较大的结直肠外科医生、规模较大的医院、教学医院和国家癌症研究所（NCI）指定的综合癌症中心治疗的患者中，长期生存率有所提高。基于对这些不同因素之间的相互作用进行建模的迭代方法，我们发现外科医生亚专科状态、医院数量和NCI指定具有强大的影响。手术量与长期生存率无明显相关性。结论：在较大容量和/或nci指定的综合癌症中心接受委员会认证的结直肠外科医生治疗的直肠癌患者总体生存率更高。在调整了广泛的患者和环境风险因素（包括外科医生数量）后，这些差异仍然存在。患者和付款人可以使用这些结果来确定外科医生和医院的结果最有利。(C) 2014年美国癌症协会。
BACKGROUND: Surgeon and hospital factors are associated with the survival of patients treated for rectal cancer. The relative contribution of each of these factors toward determining outcomes is poorly understood. METHODS: We used data from the Surveillance, Epidemiology, and End Results-Medicare database to analyze the outcomes of patients aged 65 years and older undergoing operative treatment for nonmetastatic rectal cancer, diagnosed in the United States between 1998 and 2007. These data were linked to a registry to identify whether the treating surgeon was a board-certified colorectal surgeon versus a noncolorectal surgeon. Hospital volume and hospital certification as a National Cancer Institute-designated Comprehensive Cancer Centers were also analyzed. The primary outcome of interest was long-term survival. RESULTS: Our data source yielded 6432 patients. Initial analysis demonstrated improved long-term survival in patients treated by higher-volume colorectal surgeons, higher-volume hospitals, teaching hospitals, and National Cancer Institute (NCI)-designated Comprehensive Cancer Centers. Based on an iterative approach to modeling the interactions between these various factors, we found a robust effect of surgeon subspecialty status, hospital volume, and NCI designation. Surgeon volume was not distinctly associated with long-term survival. CONCLUSIONS: Patients treated for rectal cancer by board-certified colorectal surgeons in centers that are higher volume and/or NCI-designated Comprehensive Cancer Centers experience better overall survival. These differences persist after adjustment for a broad range of patient and contextual risk factors, including surgeon volume. Patients and payers can use these results to identify surgeons and hospitals where outcomes are most favorable. (C) 2014 American Cancer Society.