背景:准确的术前分期对胃癌患者很重要。这项研究确定了Medicare胃腺癌患者内镜超声(EUS)的使用率及其相关因素。
方法:关联监测,流行病学,和最终结果(SEER)-Medicare索赔数据库在1996年至2009年间查询了接受胃切除术的胃癌患者。单变量分析,多变量,并进行了Cochran-Armitage趋势测试。
结果:5826例胃癌患者,平均年龄76.9±6.62岁,59.1%的癌症有区域性扩散。EUS利用率在研究期间从2.6%显著增加到22%(p<0.0001)。EUS患者更可能是男性,白色,已婚,有高等教育和收入四分位数,与非EUS患者相比,生活在大城市地区(p<0.0001)。即使在控制了混杂因素之后,接受EUS检查的患者更有可能接受>15个淋巴结检查(比值比(OR)1.26,95%置信区间(CI)1.04~1.53),并且接受术前和术后化疗(OR1.27,95%CI1.03~1.57).
结论:EUS目前使用不足,但正在增加。接受EUS的患者(12.9%)更有可能接受其他NCCN推荐的护理,包括围手术期化疗和充分的淋巴结恢复。
BACKGROUND: Accurate preoperative staging is important for patients with gastric cancer. This
study identifies the rate of utilization of endoscopic ultrasound (EUS) and its associated factors in Medicare patients with gastric adenocarcinoma.
METHODS: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was queried from 1996 to 2009 for patients with gastric cancer who underwent gastric resection. Analysis with univariate, multivariate, and Cochran-Armitage trend tests were performed.
RESULTS: In 5826 patients with gastric cancer with an average age of 76.9 ± 6.62 years, 59.1% had regionalized spread of cancer. EUS utilization increased significantly during the
study period from 2.6% to 22% (p < 0.0001). EUS patients were more likely to be male, white, married, have higher education and income quartiles, and live in large metropolitan areas compared to non-EUS patients (p < 0.0001). Even after controlling for confounding factors, patients who underwent EUS were more likely to have >15 lymph nodes examined (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.04-1.53) and have the administration of both pre- and postoperative chemotherapy (OR 1.27, 95% CI 1.03-1.57).
CONCLUSIONS: EUS is currently under-utilized but increasing. Patients who underwent EUS (12.9%) were more likely to receive other NCCN-recommended care, including perioperative chemotherapy and adequate nodal retrieval.