Survival of patients with colorectal peritoneal metastases is affected by treatment disparities among hospitals of diagnosis: A nationwide population-based study

被引：14

作者：

Rovers, Koen P. ^{[1
]}

Simkens, Geert A. ^{[1
]}

Vissers, Pauline A. ^{[2
]}

Lemmens, Valery E. ^{[2
,3
]}

Verwaal, Victor J. ^{[4
]}

Bremers, Andre J. ^{[5
]}

Wiezer, Marinus J. ^{[6
]}

Burger, Jacobus W. ^{[7
]}

Hemmer, Patrick H. ^{[8
]}

Boot, Henk ^{[9
]}

van Grevenstein, Wilhelmina M. ^{[10
]}

Meijerink, Wilhelmus J. ^{[11
]}

Aalbers, Arend G. ^{[12
]}

Punt, Cornelis J. ^{[13
]}

Tanis, Pieter J. ^{[14
]}

de Hingh, Ignace H. ^{[1
]}

机构：

[1] Catharina Hosp, Dept Surg, POB 1350, NL-5602 ZA Eindhoven, Netherlands

[2] Netherlands Comprehens Canc Org IKNL, Dept Res, POB 19079, NL-3501 DB Utrecht, Netherlands

[3] Erasmus MC, Dept Publ Hlth, POB 2040, NL-3000 CA Rotterdam, Netherlands

[4] Aarhus Univ Hosp, Dept Surg, Norrebrogade 44, DK-8000 Aarhus, Denmark

[5] Radboud Univ Nijmegen, Med Ctr, Dept Surg, POB 9101, NL-6500 HB Nijmegen, Netherlands

[6] St Antonius Hosp, Dept Surg, POB 2500, NL-3430 EM Nieuwegein, Netherlands

[7] Erasmus MC, Dept Surg, POB 2040, NL-3000 CA Rotterdam, Netherlands

[8] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, POB 30001, NL-9700 RB Groningen, Netherlands

[9] Antoni van Leeuwenhoek Hosp, Dept Gastroenterol & Hepatol, POB 90203, NL-1006 BE Amsterdam, Netherlands

[10] Univ Med Ctr Utrecht, Dept Surg, POB 85500, NL-3508 GA Utrecht, Netherlands

[11] Vrije Univ Amsterdam, Med Ctr, Dept Surg, POB 7057, NL-1007 MB Amsterdam, Netherlands

[12] Antoni van Leeuwenhoek Hosp, Dept Surg, POB 90203, NL-1006 BE Amsterdam, Netherlands

[13] Acad Med Ctr, Dept Med Oncol, POB 22660, NL-1100 DD Amsterdam, Netherlands

[14] Acad Med Ctr, Dept Surg, POB 22660, NL-1100 DD Amsterdam, Netherlands

来源：

EUROPEAN JOURNAL OF CANCER | 2017年 / 75卷

关键词：

Colorectal neoplasms; Peritoneal neoplasms; Peritoneal lavage; Cytoreduction surgical procedures; Colorectal surgery; Quality of health care; Health services research; Survival; Hospitals; SURGICAL-TREATMENT; CYTOREDUCTIVE SURGERY; PANCREATIC-CANCER; CARCINOMATOSIS; PROTOCOL; HIPEC;

D O I：

10.1016/j.ejca.2016.12.034

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: In the Netherlands, surgery for peritoneal metastases of colorectal cancer (PMCRC) is centralised, whereas PMCRC is diagnosed in all hospitals. This study assessed whether hospital of diagnosis affects treatment selection and overall survival (OS). Methods: Between 2005 and 2015, all patients with synchronous PMCRC without systemic metastases were selected from the Netherlands Cancer Registry. Treatment was classified as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), systemic therapy or other/no treatment. Hospitals of diagnosis were classified as: (1) non teaching or academic/teaching hospital and (2) HIPEC centre or referring hospital. Referring hospitals were further classified based on the frequency of CRS/HIPEC as high-, medium- or low-frequency hospital. Multivariable regression analyses were used to assess the independent influence of hospital categories on the likelihood of CRS/HIPEC and OS. Results: A total of 2661 patients, diagnosed in 89 hospitals, were included. At individual hospital level, CRS/HIPEC and systemic therapy ranged from 0% to 50% and 6% to 67%, respectively. Hospital of diagnosis influenced the likelihood of CRS/HIPEC: 33% versus 13% for HIPEC centres versus referring hospitals (odds ratio (OR) 3.66 [2.40-5.58]) and 11% versus 17% for non-teaching hospitals versus academic/teaching hospitals (OR 0.60 [0.47-0.77]). Hospital of diagnosis affected median OS: 14.1 versus 9.6 months for HIPEC centres versus referring hospitals (hazard ratio (HR) 0.82 [0.67-0.99]) and 8.7 versus 11.5 months for non-teaching hospitals versus academic/teaching hospitals (HR 1.15 [1.06-1.26]). Compared with diagnosis in medium-frequency referring hospitals, median OS was increased in high frequency referring hospitals (12.6 months, HR 0.82 [0.73-0.91]) and reduced in low frequency referring hospitals (8.1 months, HR 1.12 [1.01-1.24]). Conclusion: Treatment disparities among hospitals of diagnosis and their impact on survival indicate suboptimal treatment selection for PMCRC. (C) 2017 Elsevier Ltd. All rights reserved.

引用

页码：132 / 140

页数：9

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