Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base.

Autor: Becerra AZ; Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. adan_becerra@urmc.rochester.edu.; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. adan_becerra@urmc.rochester.edu., Berho ME; Department of Laboratory Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA., Probst CP; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Aquina CT; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Tejani MA; Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Gonzalez MG; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Xu Z; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Swanger AA; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Noyes K; Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA., Monson JR; Florida Hospital Medical Group, Florida Hospital, Center for Colon and Rectal Surgery, Orlando, FL, USA., Fleming FJ; Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2016 Dec; Vol. 23 (Suppl 5), pp. 674-683. Date of Electronic Publication: 2016 Sep 09.
DOI: 10.1245/s10434-016-5551-2
Abstrakt: Background: Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry.
Methods: Stage I-III colon cancer patients were identified from the 2003-2012 National Cancer Data Base. Bayesian multilevel logistic regression models were used to assess the impact of patient- and hospital-level factors on hospital-specific rates of suboptimal lymphadenectomy (<12 lymph nodes), and multilevel Cox models were used to estimate the effect of suboptimal lymphadenectomy at the patient (yes vs. no) and hospital level (quartiles of hospital-specific rates) on overall survival.
Results: A total of 360,846 patients across 1345 hospitals in the US met the inclusion criteria, of which 25 % had a suboptimal lymphadenectomy. Wide variation was observed in hospital-specific rates of suboptimal lymphadenectomy (range 0-82 %, median 44 %). Older age, male sex, comorbidity score, no insurance, positive margins, lower tumor grade, lower T and N stage, and sigmoid and left colectomy were associated with higher odds of suboptimal lymphadenectomy. Patients treated at lower-volume and non-academic hospitals had higher odds of suboptimal lymphadenectomy. Patient- and hospital-level factors explained 5 % of the between-hospital variability in suboptimal lymphadenectomy, leaving 95 % unexplained. Higher suboptimal lymphadenectomy rates were associated with worse survival (quartile 4 vs. quartile 1: hazard ratio 1.19, 95 % confidence interval 1.16-1.22).
Conclusion: Large differences in hospital-specific rates of suboptimal lymphadenectomy were observed, and this variation was associated with survival. Quality improvement initiatives targeting hospital-level adherence to the national standard may improve overall survival among resected colon cancer patients.
Databáze: MEDLINE
Externí odkaz: