Assessment of a collaborative treatment model for trimodal management of esophageal cancer.

Autor:	Udelsman BV; Division of Thoracic Surgery, Department of Surgery University of Southern California, Los Angeles, CA, USA., Ermer T; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.; London School of Hygiene and Tropical Medicine, University of London, London, UK., Ely S; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA., Canavan ME; Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Zhan P; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA., Boffa DJ; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA., Blasberg JD; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2023 Sep 28; Vol. 15 (9), pp. 4668-4680. Date of Electronic Publication: 2023 Aug 25.
DOI:	10.21037/jtd-23-346
Abstrakt:	Background: Patients with esophageal cancer often receive care in a collaborative (multi-institutional) treatment model as opposed to a single institutional model. The effect of a collaborative model on the quality of trimodality therapy and survival is unknown. Methods: The National Cancer Database (NCDB) was used to identify patients receiving neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy for esophageal cancer between 2012-2017. Patients who received neoadjuvant therapy and surgery at a single institution were compared to those that received collaborative treatment across multiple institutions. Outcomes included adherence to guideline recommended multiagent chemotherapy, receipt of 41.4-50.4 Gy of radiation, R0 resection, pathologic complete response (pCR), and 5-year survival. Sociodemographics, comorbidities, and tumor characteristics were assessed in bivariate and multivariable analysis. Results: Among 8,396 patients identified, 39% received treatment at a single institution, while 61% received collaborative treatment. Median travel distance to the site of esophagectomy was two times greater for patients receiving collaborative treatment (30 vs. 15 miles; P<0.001). Patients in the collaborative cohort were less likely to receive guideline-recommended multiagent chemotherapy (85% vs. 96%; P<0.001) and 41.4-50.4 Gy of radiation (89% vs. 91%; P=0.01). R0 resection rates were similar (94.4% vs. 93.7%; P=0.17). Patients who received collaborative treatment had an increased rate of pCR (24% vs. 22%; P=0.02). Overall, 90-day and 5-year survival were 92.9% and 42.6% respectively and did not differ significantly between the two groups. Conclusions: Collaborative trimodality treatment of esophageal cancer is a common and reasonable practice model, which may alleviate patient travel burden with only a modest impact on the quality of CRT, pCR, 90-day survival, and 5-year survival. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-346/coif). DJB was paid a stipend from Iovance to attend a panel discussion on cell-based therapy that was unrelated to this work. The other authors have no conflicts of interest to declare. (2023 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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