胆囊癌手术治疗的相关因素--基于医疗保险的监测、流行病学和最终结果研究

IF 1.8 3区 医学 Q2 SURGERY Journal of Surgical Research Pub Date : 2024-10-31 DOI:10.1016/j.jss.2024.09.084
{"title":"胆囊癌手术治疗的相关因素--基于医疗保险的监测、流行病学和最终结果研究","authors":"","doi":"10.1016/j.jss.2024.09.084","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.</div></div><div><h3>Materials and methods</h3><div>SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% <em>versus</em> 65.6%; <em>P</em> = 0.0104), ≥80 y old (48.2% <em>versus</em> 22.4%; <em>P</em> &lt; 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> &lt; 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> &lt; 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> &lt; 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> &lt; 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% <em>versus</em> 47.2%; <em>P</em> &lt; 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> &lt; 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Associated With Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study\",\"authors\":\"\",\"doi\":\"10.1016/j.jss.2024.09.084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.</div></div><div><h3>Materials and methods</h3><div>SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% <em>versus</em> 65.6%; <em>P</em> = 0.0104), ≥80 y old (48.2% <em>versus</em> 22.4%; <em>P</em> &lt; 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> &lt; 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> &lt; 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> &lt; 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> &lt; 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% <em>versus</em> 47.2%; <em>P</em> &lt; 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> &lt; 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.</div></div>\",\"PeriodicalId\":17030,\"journal\":{\"name\":\"Journal of Surgical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-10-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022480424006486\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480424006486","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

摘要

导言胆囊癌(GBC)的发病率不断上升,但预后仍然很差。T1b期或以上的肿瘤切除术可提高生存率,但许多患者并未接受适当的切除术。本研究旨在利用监测、流行病学和最终结果--医疗保险(SEER-Medicare)数据库评估可能导致这一差异的因素。材料和方法SEER医疗保险(2008-2015年)中T1b期或以上GBC患者被分为接受单纯胆囊切除术(CCY)或胆囊切除术和肝/胆切除术(肿瘤切除术)。对分类变量和连续变量分别采用Chi-square检验和Wilcoxon秩和检验,比较了基线特征倾向得分匹配前后的结果和总生存率。CCY 患者多为女性(73.4% 对 65.6%;P = 0.0104)、≥80 岁(48.2% 对 22.4%;P <;0.0001)、体弱(44.5% 对 27.1%;P <;0.0001)、由普通外科医生治疗(98.1%对84.9%;P <;0.0001)与肿瘤外科医生相比,未接受化疗(72.3%对54.5%;P <;0.0001),在非学术医院管理(51.2%对28.4%;P <;0.0001)。匹配后,与 CCY 相比,肿瘤切除术的总生存率在 1y (69.2% 对 47.2%; P < 0.0001)、3y (42.8% 对 21.1%; P < 0.0001) 和 5y (37.5% 对 17.4%; P < 0.0001) 均有所提高。结论大多数GBC患者可能没有接受适当的肿瘤切除术,尤其是女性、老年、体弱、由普通外科医生手术、未接受化疗或在非学术医院接受治疗的患者。即使对患者因素进行调整,完全切除仍与多个终点的总体生存结果相关。限制性别、年龄和体弱状况等因素,并让肿瘤外科医生参与或在学术中心接受治疗,可能会提高肿瘤切除率,从而改善 GBC 患者的生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Factors Associated With Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study

Introduction

Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.

Materials and methods

SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.

Results

We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% versus 65.6%; P = 0.0104), ≥80 y old (48.2% versus 22.4%; P < 0.0001), frail (44.5% versus 27.1%; P < 0.0001), treated by general surgeons (98.1% versus 84.9%; P < 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% versus 54.5%; P < 0.0001), managed at nonacademic hospitals (51.2% versus 28.4%; P < 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% versus 47.2%; P < 0.0001), 3-y (42.8% versus 21.1%; P < 0.0001), and 5-y (37.5% versus 17.4%; P < 0.0001).

Conclusions

Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
3.90
自引率
4.50%
发文量
627
审稿时长
138 days
期刊介绍: The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.
期刊最新文献
Rodent Model of Cardiopulmonary Bypass Demonstrates Systemic Inflammation and NeuroMarker Changes Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study Vascular Graft Infections Treated With Bioabsorbable Antibiotic Beads Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery Outcomes of Gastroschisis and Omphalocele Treated at Children’s Surgery Verified Centers in Texas
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1