Enhanced recovery and survival after elective surgery for colorectal cancer - propensity score weighting analysis of 2,865 prospective patients

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-08-17 DOI:10.1016/j.ejso.2025.110379

Marco Catarci , Stefano Guadagni , Marco Scatizzi , Raffaele De Luca , Paolo Delrio , Giacomo Ruffo , Felice Borghi , Francesco Masedu

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引用次数: 0

Abstract

Background

The impact of enhanced recovery pathway (ERP) on survival after colorectal cancer surgery (CCS) remains controversial.

Materials and methods

A total of 2865 adults enrolled in a multicenter cohort study (iCral3 study) after CCS were followed up. The percentage adherence to the ERP was recorded, and the patients were grouped according to their quartiles. Other patient-, center-, disease-, and treatment-related factors were considered in a machine learning generalized boosted model (GBM) to estimate the 22 covariates propensity score weights for the binary comparisons between the reference treatment (1st quartile, ERP adherence rates <57.7 %) and the other treatment arms (2nd, 3rd, and 4th quartile). The primary endpoint was overall survival (OS). A GBM-weighted Cox model balanced on the same covariates was used to estimate the hazard ratio (HR) and 95 % confidence interval (95 %CI).

Results

Patients in the 4th quartile (ERP adherence rates ≥80.8 %) showed a significant lower risk of death from any cause (HR, 0.69; 95 %CI 0.49–0.96; p = 0.026).

Conclusions

High adherence to ERP was associated to a significant impact on long-term overall survival, supporting the efforts towards proper ERP implementation after CCS.

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结直肠癌择期手术后增强的恢复和生存——2865名预期患者的倾向评分加权分析

背景：增强恢复通路（enhanced recovery pathway， ERP）对结直肠癌手术（CCS）后存活的影响仍存在争议。材料和方法共2865名成人在CCS后参加了一项多中心队列研究（iCral3研究）。记录ERP的依从性百分比，并根据患者的四分位数进行分组。在机器学习广义增强模型（GBM）中考虑其他与患者、中心、疾病和治疗相关的因素，以估计参考治疗（第1四分位数，ERP依从率<； 57.7%）和其他治疗组（第2、3和4四分位数）之间二元比较的22个共变量倾向评分权重。主要终点是总生存期（OS）。使用基于相同协变量的gbm加权Cox模型来估计风险比（HR）和95%置信区间（95% CI）。结果第4四分位数患者（ERP依从率≥80.8%）的任何原因死亡风险显著降低（HR为0.69；95% CI为0.49-0.96;p = 0.026）。结论：高依从性ERP对长期总体生存有显著影响，支持CCS后适当实施ERP的努力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.