“教科书级”肿瘤学结局是一种简便的复合质量指标，与晚期卵巢癌患者的生存密切相关

Textbook oncologic outcome is an easy-to-use composite quality measure that is strongly associated with survival in advanced-stage ovarian cancer

GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Dec

作者: Giuseppe Caruso, Carrie L Langstraat, Amanika Kumar, Michaela E McGree, Angela J Fought, Dimitrios Nasioudis, Giovanni D Aletti, Nicoletta Colombo, Robert L Giuntoli, William A Cliby

DOI: 10.1016/j.ygyno.2024.09.018

摘要

“教科书级”肿瘤学结局（TOO）已在外科肿瘤学中被验证为一种与肿瘤学结局相关的复合质量指标。我们旨在评估TOO与晚期上皮性输卵管卵巢癌（AEOC）患者总体生存（OS）的关系。筛选2008年至2019年间在国家癌症数据库（NCDB）接受手术治疗的AEOC患者。分别分析主要减瘤手术（PDS）和中期减瘤手术（IDS）两组。TOO定义为完成完全减瘤、住院天数<10天、30天内未再入院、90天内无死亡以及在42天内开始辅助化疗。采用Kaplan-Meier法估算不同TOO状态下的5年生存率，并利用Cox回归分析TOO与5年内死亡的关系。共纳入21,657例患者：PDS组占51.4%，IDS组占48.6%。TOO达成（TOO+）的比例分别为20.5%（PDS）和39.2%（IDS）。在PDS组，达成TOO显著提高5年生存率：TOO+为59.0%，TOO-为39.5%（HR 0.53，95% CI 0.49-0.57）；在IDS组亦如此：TOO+为43.9%，TOO-为31.2%（HR 0.67，95% CI 0.63-0.70）。多变量分析显示，达成TOO的患者在5年内死亡风险较低：PDS组HR为0.58（95% CI 0.54-0.62），IDS组HR为0.69（95% CI 0.65-0.73）。TOO作为一种复合指标，能反映患者的长期生存预后，且不论手术时间，都可作为衡量治疗质量的有效工具。它通过多学科协作实现个体化风险管理，具有重要的临床应用价值。

Abstract

Textbook oncologic outcome (TOO) has been validated in surgical oncology as a composite quality measure correlated with oncologic outcomes. We aimed to assess the association between TOO and overall survival (OS) in patients undergoing primary treatment for advanced epithelial tubo-ovarian cancer (AEOC).Patients undergoing surgery for AEOC between 2008 and 2019 were identified in the National Cancer Database (NCDB). Primary debulking surgery (PDS) and interval debulking surgery (IDS) cohorts were analyzed separately. TOO was defined as achieving complete debulking, length of hospital stay <10 days, no 30-day readmission, no death within 90 days, and initiation of adjuvant chemotherapy within 42 days. The Kaplan-Meier method was used to estimate 5-year OS by TOO status and Cox regression to evaluate the relationship between TOO and death within 5 years.A total of 21,657 patients were included: 51.4% in the PDS cohort and 48.6% in the IDS cohort. TOO was achieved (TOO+) in 20.5% of the PDS cohort and 39.2% of the IDS cohort. For the PDS cohort, achieving TOO was associated with improved 5-year OS: 59.0% TOO+ vs. 39.5% TOO- (HR 0.53, 95% CI 0.49-0.57). For the IDS cohort, a similar benefit was seen for 5-year OS: 43.9% TOO+ vs. 31.2% TOO- (HR 0.67, 95% CI 0.63-0.70). Multivariable analysis demonstrated that patients achieving TOO were at lower risk of death within 5 years in both the PDS cohort (HR 0.58, 95% CI 0.54-0.62) and the IDS cohort (HR 0.69, 95% CI 0.65-0.73).The TOO composite measure is associated with improved long-term survival and could be a useful quality assessment tool for patients undergoing primary treatment for AEOC, irrespective of surgical timing. This tool reflects the ability to deliver risk-based individualized decision-making using a multidisciplinary approach.