转移性肾上腺皮质癌的住院姑息治疗:利用全国住院病人抽样数据库进行的回顾性分析。

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2024-09-30 DOI:10.23736/S2724-6507.24.04185-X
Letizia M Jannello, Carolin Siech, Andrea Baudo, Mario de Angelis, Francesco DI Bello, Jordan A Goyal, Zhe Tian, Stefano Luzzago, Francesco A Mistretta, Elisa de Lorenzis, Fred Saad, Felix K Chun, Alberto Briganti, Luca Carmignani, Nicola Longo, Ottavio de Cobelli, Gennaro Musi, Pierre I Karakiewicz
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引用次数: 0

摘要

背景:在晚期癌症患者中使用住院姑息治疗(IPC)是一项行之有效的指南建议。本研究探讨了转移性肾上腺皮质癌(mACC)患者使用姑息治疗的比例和模式:方法:根据全国住院患者抽样数据库(2007-2019 年),我们统计了 mACC 患者的 IPC 使用率。结果:在 2040 名 mACC 患者中,有 1.6% 的患者使用了 IPC:在 2040 名 mACC 患者中,238 人(12%)接受了 IPC。总体而言,2007年至2019年期间,IPC的使用率从3.7%增至19.1%(EAPC +9.6%,P=0.001)。同期,院内死亡率保持不变,从12.1%降至13.8%(EAPC 0.1%;P=0.97)。入院时年龄较小(结论:在 mACC 患者中,IPC 的使用率已从 3.7% 的微弱水平上升到最近研究年度 19.1% 的中等水平。院内死亡率(从12.1%上升到13.8%;P=0.9)并没有随之增加。尽管这一增长令人鼓舞,但一些患者的特征预示着IPC的使用率较低。因此,应慎重考虑年轻患者、单发转移部位患者和非脑部转移患者使用IPC,以最大限度地减少或完全消除IPC使用障碍。
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Inpatient palliative care in metastatic adrenocortical carcinoma: a retrospective analysis using the National Inpatient Sample database.

Background: The use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. This study examines the utilization rates and patterns of IPC among patients with metastatic adrenocortical carcinoma (mACC).

Methods: Relying on the Nationwide Inpatient Sample database (2007-2019), we tabulated IPC rates in mACC patients. Estimated annual percentage changes (EAPC) analyses as well as multivariable logistic regression models (MLRM) predicting IPC use were fitted.

Results: Of 2040 mACC patients, 238 (12%) received IPC. Overall, the rate of IPC increased from 3.7% to 19.1% between 2007 and 2019 (EAPC +9.6%, P=0.001). During the same period, in-hospital mortality remained unchanged from 12.1 to 13.8% (EAPC 0.1%; P=0.97). Younger age at admission (<60 years; MLRM OR=0.70, P=0.013), solitary metastatic site (OR=0.63; P=0.015), and non-brain metastases (OR=0.62; P=0.033) were all associated with lower IPC use.

Conclusions: In mACC patients, IPC use has increased from a marginal 3.7% to a moderate annual value of 19.1% in the most recent study year. These rates were not driven by a concomitant increase in in-hospital mortality (12.1% to 13.8%; P=0.9). and may be interpreted as an improvement in quality of care. Despite this encouraging increase, some patient characteristics herald lower IPC use. In consequence, younger patients, those with solitary metastatic sites, and non-brain metastases should be carefully considered for IPC to decrease or completely reduce the IPC access barrier maximally.

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