文章：

胰腺癌患者持续未能获得指南一致性照护

Ongoing Failure to Deliver Guideline-Concordant Care for Patients with Pancreatic Cancer

原文发布日期：7 January 2025

DOI: 10.3390/cancers17020170

类型: Article

开放获取: 是

英文摘要：

(1) Background: Comprehensive evaluation of guideline-concordant care (GCC) across all PDAC stages has yet to be thoroughly conducted. This study aimed to characterize treatment patterns and assess factors associated with receiving GCC among patients with pancreatic ductal adenocarcinoma (PDAC) in California. (2) Methods: Data on adult patients with PDAC were extracted from the California Cancer Registry (2004–2020). GCC is defined according to the recommendations provided by the National Comprehensive Cancer Network. We used multivariable logistic regression to identify factors associated with receiving GCC. A Cox model was used to examine the association of GCC with overall survival. (3) Results: A total of 50,346 PDAC patients were included (stage 1: 10%; stage 2: 25%; stage 3: 11%; stage 4: 54%). Only 46.7% of all patients received GCC (stage 1: 20%; stage 2: 40%; stage 3: 69%; stage 4: 50%). Only 31% of stage 1 patients underwent surgery. Factors inversely associated with receiving GCC were Hispanic ethnicity (OR 0.78;p< 0.001), Black race (OR 0.74;p< 0.001), having no insurance (OR 0.40;p< 0.001]), and a Charlson–Deyo score of ≥2 (OR 0.68;p< 0.001). Adherence to GCC was associated with improved survival (Hazard Ratio 0.39;p< 0.001). Notably, patients with stage 1 PDAC who received GCC had a median survival of 47 months vs. 8 months for those who did not. (4) Conclusions: Although stage 1 PDAC patients have the greatest potential for survival with GCC, only 20% of patients received such treatment. Thus, it is crucial to identify and address the modifiable factors contributing to these suboptimal care patterns.

摘要翻译： 

（1）背景：目前尚未对不同分期的胰腺导管腺癌（PDAC）患者接受指南一致性治疗（GCC）的情况进行全面评估。本研究旨在分析加利福尼亚州PDAC患者的治疗模式，并探讨影响其接受GCC的相关因素。（2）方法：从加利福尼亚州癌症登记处（2004–2020年）提取成年PDAC患者数据。GCC的定义依据美国国家综合癌症网络指南建议。采用多变量逻辑回归分析识别与接受GCC相关的因素，并运用Cox模型评估GCC与总生存期的关联性。（3）结果：共纳入50,346例PDAC患者（Ⅰ期：10%；Ⅱ期：25%；Ⅲ期：11%；Ⅳ期：54%）。总体仅46.7%的患者接受了GCC（Ⅰ期：20%；Ⅱ期：40%；Ⅲ期：69%；Ⅳ期：50%）。值得注意的是，仅31%的Ⅰ期患者接受了手术治疗。与接受GCC呈负相关的因素包括：西班牙裔（OR 0.78；p<0.001）、黑人种族（OR 0.74；p<0.001）、无医疗保险（OR 0.40；p<0.001）以及查尔森合并症指数≥2分（OR 0.68；p<0.001）。遵循GCC与生存改善显著相关（风险比0.39；p<0.001），其中接受GCC的Ⅰ期PDAC患者中位生存期达47个月，而未接受者仅为8个月。（4）结论：尽管Ⅰ期PDAC患者通过GCC治疗可能获得最佳生存获益，但仅20%的患者接受了规范治疗。因此，识别并改善导致这种非理想治疗模式的可调控因素至关重要。

原文链接：

Ongoing Failure to Deliver Guideline-Concordant Care for Patients with Pancreatic Cancer