同步结直肠肝转移患者局部治疗的选择和手术切除的结果：一项基于全国人群的研究。

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-08-28 DOI:10.1016/j.ejso.2025.110411

Michelle R. de Graaff , Joost M. Klaase , Macel den Dulk , Dirk J. Grünhagen , R.-J. Swijnenburg , G. Kazemier , M. Liem , E.J.T. Belt , M. Vermaas , J.S.D. Mieog , P. Gobardhan , A. Rijken , S.J. Oosterling , K. Bosscha , Niels F.M. Kok , MarloesA.G. Elferink

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引用次数: 0

摘要

背景：本研究的目的是评估同步性结直肠肝转移（CRLM）患者接受手术治疗概率的潜在差异，并探讨哪些非肿瘤相关特征影响术后预后。方法：这是一项基于人群的研究，研究对象是荷兰2015年至2021年间诊断为同步CRLM的所有患者。数据来自荷兰癌症登记处（NCR），接受手术探查的患者数据来自荷兰肝胆道审计（DHBA）。采用多变量logistic回归模型评估非肿瘤相关因素、局部治疗CRLM的机会和切除后预后之间的关系。结果：NCR共纳入14047例同步CRLM患者。其中2753例（20%）患者接受了CRLM的局部治疗。与局部治疗CRLM可能性较低相关的非肿瘤相关因素包括年龄（OR 0.94 95% CI 0.94-0.95）和女性性别（OR 0.87, 95% CI 0.78-0.97）。中高社会经济地位（SES）与低社会经济地位（分别为OR 1.35, 95% CI 1.18-1.54和OR 1.61, 95% CI 1.41-1.84）和在医院进行肝脏手术（OR 1.52, 95% CI 1.26-1.84）与获得局部治疗的可能性较高相关。从DHBA中纳入了2535例患者。与主要发病率和死亡率相关的非肿瘤相关因素包括年龄（分别为OR 1.01, 95% CI 1.00-1.03和OR 1.07, 95% CI 1.02-1.11）和asa评分≥3 （OR 1.7, 95% CI 1.34-2.29和OR 2.88, 95 CI 1.92-1.11）。结论：除肿瘤相关因素外，年龄、男性、社会经济地位、就诊医院等非肿瘤相关因素均影响CRLM局部治疗的可能性。由于并非所有这些因素都会影响术后结果，医疗保健系统还应侧重于消除获得适当护理的障碍。

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Selection for local treatment and outcomes of surgical resection in patients with synchronous colorectal liver metastases: A nationwide population-based study

Background

The aim of this study was to evaluate potential disparities in the probability of undergoing surgical treatment among patients with synchronous colorectal liver metastases (CRLM) and to investigate which non-tumour-related characteristics influenced postoperative outcomes.

Methods

This was a population-based study of all patients diagnosed with synchronous CRLM between 2015 and 2021 in the Netherlands. Data were retrieved from the Netherlands Cancer Registry (NCR) and data of patients who underwent surgical exploration were retrieved from the Dutch Hepato Biliary Audit (DHBA). The association between non-tumour-related factors, the chance of getting local treatment of CRLM and outcomes after resection were evaluated using multivariable logistic regression models.

Results

From the NCR, 14,047 patients with synchronous CRLM were included. Of these 2753 (20 %) patients underwent local treatment of CRLM. Non-tumour-related factors associated with a lower likelihood of local treatment of CRLM included age (OR 0.94 95 %CI 0.94–0.95) and female sex (OR 0.87, 95 %CI 0.78–0.97). Middle and high Socioeconomic status (SES) compared to low SES (respectively OR 1.35, 95 %CI 1.18–1.54 and OR 1.61, 95 %CI 1.41–1.84) and presentation in a hospital that performed liver surgery (OR 1.52, 95 %CI 1.26–1.84) were associated with a higher likelihood of getting local treatment. From the DHBA 2535 patients were included. Non-tumour-related factors associated with both major morbidity and mortality included age (OR 1.01 95 %CI 1.00–1.03 and OR 1.07, 95 %CI 1.02–1.11, respectively) and ASA-score ≥3 (OR 1.7,95 %CI 1.34–2.29 and OR 2.88, 95 CI 1.92–1.11) respectively.

Conclusion

In addition to tumour-related factors, non-tumour-related factors, including age, male sex, SES and hospital of presentation, all contributed to the likelihood of getting local treatment for CRLM. As not all these factors influence postoperative outcomes, healthcare systems should also focus on eliminating barriers to accessing appropriate care.

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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.