{"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> < 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> < 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> < 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> < 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> < 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> < 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> < 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> < 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> < 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> < 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> < 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> < 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> < 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> < 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> < 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> < 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}
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.
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.