Mohamedraed Elshami , Jonathan J. Hue , Alexander W. Loftus , Richard S. Hoehn , John B. Ammori , Jeffrey M. Hardacre , J. Eva Selfridge , David Bajor , Amr Mohamed , Sakti Chakrabarti , Amit Mahipal , Jordan M. Winter , Lee M. Ocuin
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Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease.</p></div><div><h3>Results</h3><p>A total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease.</p></div><div><h3>Conclusions</h3><p>Early-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. Guideline compliance is associated with improved OS regardless of age of onset or clinical stage.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000021/pdfft?md5=ee8851e6fe9c5395334dababa5f49c97&pid=1-s2.0-S2950247024000021-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Differences in receipt of guideline-compliant care and survival for early-onset versus average-onset biliary tract cancers\",\"authors\":\"Mohamedraed Elshami , Jonathan J. Hue , Alexander W. Loftus , Richard S. Hoehn , John B. Ammori , Jeffrey M. Hardacre , J. Eva Selfridge , David Bajor , Amr Mohamed , Sakti Chakrabarti , Amit Mahipal , Jordan M. Winter , Lee M. Ocuin\",\"doi\":\"10.1016/j.soi.2024.100006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>We examined differences in receipt of guideline-compliant care in patients with early-onset versus average-onset biliary tract cancers (BTC) in localized or metastatic settings. Additionally, we examined associations between guideline compliance and overall survival (OS), stratified by age of onset and clinical stage.</p></div><div><h3>Methods</h3><p>Patients with BTC [intrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma] were identified within the National Cancer Database (2010–2018). Early onset was defined as diagnosis at < 50 and average onset at ≥ 70 years. Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease.</p></div><div><h3>Results</h3><p>A total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease.</p></div><div><h3>Conclusions</h3><p>Early-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. 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引用次数: 0
摘要
背景我们研究了局部或转移性胆道癌(BTC)早发患者与普通患者接受符合指南要求的治疗的差异。方法在国家癌症数据库(2010-2018 年)中确定了 BTC 患者(肝内胆管癌、胆囊腺癌、肝外胆管癌)。早期发病定义为诊断年龄为 50 岁,平均发病年龄≥ 70 岁。符合指南的治疗定义为局部疾病的手术切除和化疗,以及转移性疾病的多药化疗。结果共发现32247名患者,其中2855名患者(8.9%)为早发疾病。早发患者在发病时更有可能患有转移性疾病。早发患者更有可能在局部(OR=2.24,95% CI:1.93-2.60)和转移(OR=4.40,95% CI:3.72-5.21)情况下接受符合指南的治疗。在局部 BTC 患者中,遵守指南与早期(中位 OS:51.9 个月对 13.5 个月;HR=0.31,95% CI:0.27-0.37)和平均发病期(中位 OS:25.9 个月对 6.1 个月;HR=0.31,95% CI:0.30-0.32)疾病的 OS 改善相关。在转移性 BTC 患者中,在早期(中位 OS:10.1 个月 vs. 3.5 个月;HR=0.52,95% CI:0.43-0.62)和一般发病期(中位 OS:8.6 个月 vs. 2.2 个月;HR=0.45,95% CI:0.43-0.48)疾病中,遵循指南与 OS 改善相关。无论发病年龄或临床分期如何,遵照指南治疗都能改善患者的OS。
Differences in receipt of guideline-compliant care and survival for early-onset versus average-onset biliary tract cancers
Background
We examined differences in receipt of guideline-compliant care in patients with early-onset versus average-onset biliary tract cancers (BTC) in localized or metastatic settings. Additionally, we examined associations between guideline compliance and overall survival (OS), stratified by age of onset and clinical stage.
Methods
Patients with BTC [intrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, extrahepatic cholangiocarcinoma] were identified within the National Cancer Database (2010–2018). Early onset was defined as diagnosis at < 50 and average onset at ≥ 70 years. Guideline-compliant care was defined as surgical resection ± chemotherapy for localized disease and multi-agent chemotherapy for metastatic disease.
Results
A total of 32,247 patients were identified, of whom 2855 patients (8.9%) had early-onset disease. Early-onset patients were more likely to have metastatic disease at presentation. Early-onset patients were more likely to receive guideline-compliant care in both localized (OR=2.24, 95% CI: 1.93–2.60) and metastatic (OR=4.40, 95% CI: 3.72–5.21) settings. Among patients with localized BTC, guideline compliance was associated with improved OS in both early (median OS: 51.9 vs. 13.5 months; HR=0.31, 95% CI: 0.27–0.37) and average-onset (median OS: 25.9 vs. 6.1 months; HR=0.31, 95% CI: 0.30–0.32) disease. Among patients with metastatic BTC, guideline compliance was associated with improved OS in both early (median OS: 10.1 vs. 3.5 months; HR=0.52, 95% CI: 0.43–0.62) and average-onset (median OS: 8.6 vs. 2.2 months; HR=0.45, 95% CI: 0.43–0.48) disease.
Conclusions
Early-onset BTC is associated with more frequent guideline-compliant care regardless of clinical stage. Guideline compliance is associated with improved OS regardless of age of onset or clinical stage.