邻域层面的社会经济劣势预测了腹膜恶性肿瘤腹腔减容手术及热化学腹腔内温热疗法的结果。
Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy.
发表日期：2023 Aug 24
作者：
Nolan M Winicki, Shannon N Radomski, Isabella S Florissi, Jordan M Cloyd, Goutam Gutta, Travis E Grotz, Christopher P Scally, Keith F Fournier, Sean P Dineen, Benjamin D Powers, Jula Veerapong, Joel M Baumgartner, Callisia N Clarke, Anai N Kothari, Ugwuji N Maduekwe, Sameer H Patel, Gregory C Wilson, Patrick Schwartz, Patrick R Varley, Mustafa Raoof, Byrne Lee, Ibrahim Malik, Fabian M Johnston, Jonathan B Greer
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
细胞减量手术和热化疗（CRS/HIPEC）改善了腹腔转移（PM）患者中的特定患者的生存率，但社会卫生决定因素对CRS/HIPEC结局的影响尚不清楚。在2000年至2017年间，对在美国接受CRS/HIPEC的PM患者的多机构数据库进行了回顾性研究。将区域剥夺指数（ADI）与患者的居住地址关联。将患者分为低（1-49）和高（50-100）ADI住所两类，得分递增表示较高的社会经济不利因素。主要结果是总生存率（OS）。次要结果包括围手术期并发症、住院/重症监护室（ICU）住院时间（LOS）和无病生存率（DFS）。在1675名患者中，1061名（63.3%）居住在低ADI地区，614名（36.7%）居住在高ADI地区。小肠附睾肿瘤（n = 1102，65.8%）和结肠癌（n = 322，19.2%）是最常见的组织学类型。多变量分析显示，高ADI与围手术期并发症、住院/ICU LOS或DFS的增加无关。高ADI与较差的OS相关（中位期尚未达成，相比之下为49个月；5年OS分别是61.0%和28.2%，P < 0.0001）。多变量Cox回归分析显示，高ADI（HR，2.26；95% CI，1.13-4.50；P < 0.001）、癌症复发（HR，2.26；95% CI，1.61-3.20；P < 0.0001）、腹腔癌症指数增加（HR，1.03；95% CI，1.01-1.05；P < 0.001）和不完全清除细胞（HR，4.48；95% CI，3.01-6.53；P < 0.0001）与较差的OS相关。即使在控制癌症特异性变量后，邻里水平的社会经济不利因素仍存在不利结果。需要进一步研究个体和结构水平的因素，以改善所有患有腹腔恶性肿瘤的患者的结局。© 2023. Society of Surgical Oncology.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves survival in select patients with peritoneal metastases (PM), but the impact of social determinants of health on CRS/HIPEC outcomes remains unclear.A retrospective review was conducted of a multi-institutional database of patients with PM who underwent CRS/HIPEC in the USA between 2000 and 2017. The area deprivation index (ADI) was linked to the patient's residential address. Patients were categorized as living in low (1-49) or high (50-100) ADI residences, with increasing scores indicating higher socioeconomic disadvantage. The primary outcome was overall survival (OS). Secondary outcomes included perioperative complications, hospital/intensive care unit (ICU) length of stay (LOS), and disease-free survival (DFS).Among 1675 patients 1061 (63.3%) resided in low ADI areas and 614 (36.7%) high ADI areas. Appendiceal tumors (n = 1102, 65.8%) and colon cancer (n = 322, 19.2%) were the most common histologies. On multivariate analysis, high ADI was not associated with increased perioperative complications, hospital/ICU LOS, or DFS. High ADI was associated with worse OS (median not reached versus 49 months; 5 year OS 61.0% versus 28.2%, P < 0.0001). On multivariate Cox-regression analysis, high ADI (HR, 2.26; 95% CI 1.13-4.50; P < 0.001), cancer recurrence (HR, 2.26; 95% CI 1.61-3.20; P < 0.0001), increases in peritoneal carcinomatosis index (HR, 1.03; 95% CI 1.01-1.05; P < 0.001), and incomplete cytoreduction (HR, 4.48; 95% CI 3.01-6.53; P < 0.0001) were associated with worse OS.Even after controlling for cancer-specific variables, adverse outcomes persisted in association with neighborhood-level socioeconomic disadvantage. The individual and structural-level factors leading to these cancer disparities warrant further investigation to improve outcomes for all patients with peritoneal malignancies.© 2023. Society of Surgical Oncology.