背景:机器人手术已成为可切除肺癌的越来越多的方法。然而,某些患者人群的可用性可能有限,强调在获得创新手术技术方面的不平等。我们假设健康的社会决定因素与可切除的非小细胞肺癌(NSCLC)的机器人手术利用率之间存在关联。
方法:我们查询了国家癌症数据库(2010-2019)中接受切除的临床I-III期NSCLC患者,根据手术技术对队列进行分层。进行了多变量逻辑回归分析,以确定社会人口统计学和临床病理因素与机器人方法之间的关联。
结果:在226,455临床I-III期非小细胞肺癌患者中,34,059(15%)接受了机器人切除,78,039(34.5%)接受了胸腔镜切除术,和114,357(50.5%)进行了开放切除。机器人手术使用率从2010年的3.1%上升到2019年的34%(P<0.001)。尽管如此,按临床分期调整后,切除范围,肿瘤部位,接受新辅助治疗,多变量分析揭示了与这种方法未充分利用相关的各种社会人口统计学和治疗设施因素:缺乏保险(调整后的优势比[aOR]0.83,95%置信区间[CI]0.73-0.93),低收入阶层(AOR0.93,95%CI0.91-0.96),省级设置(城市AOR0.79,95%CI0.76-0.82;农村AOR0.57,95%CI0.51-0.64),和社区中心的治疗(综合社区癌症计划aOR0.73,95%CI0.70-0.75;社区癌症计划aOR0.51,95%CI0.47-0.55)。
结论:这项研究表明,健康决定因素的差异会影响可切除NSCLC的机器人手术的可及性。查明这些差距对于针对人口中的弱势群体,以促进手术治疗的平等和统一至关重要。
BACKGROUND: Robotic surgery has become an increasingly utilized approach for resectable lung cancer. However, availability may be limited for certain patient populations, underscoring inequity in access to innovative surgical techniques. We hypothesize that there is an association between social determinants of health and robotic surgery utilization for resectable non-small cell lung cancer (NSCLC).
METHODS: We queried the National Cancer Database (2010-2019) for patients with clinical stage I-III NSCLC who underwent resection, stratifying the cohort based on surgical technique. Multivariable logistic regression analysis was performed to identify associations between sociodemographic and clinicopathologic factors and the robotic approach.
RESULTS: Among the 226,455 clinical stage I-III NSCLC patients identified, 34,059 (15%) received robotic resections, 78,039 (34.5%) underwent thoracoscopic resections, and 114,357 (50.5%) had open resections. Robotic surgery utilization increased from 3.1% in 2010 to 34% in 2019 (P < 0.001). Despite this, after adjusting by clinical stage, extent of resection, site of tumor, and receipt of neoadjuvant therapy, multivariable analysis revealed various sociodemographic and treatment facility factors that were associated with underutilization of this approach: lack of insurance (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.73-0.93), lower income brackets (aOR 0.93, 95% CI 0.91-0.96), provincial settings (urban aOR 0.79, 95% CI 0.76-0.82; rural aOR 0.57, 95% CI 0.51-0.64), and treatment at community centers (comprehensive community cancer programs aOR 0.73, 95% CI 0.70-0.75; community cancer programs aOR 0.51, 95% CI 0.47-0.55).
CONCLUSIONS: This study suggests that disparities in determinants of health influence accessibility to robotic surgery for resectable NSCLC. Identification of these gaps is crucial to target vulnerable sectors of the population in promoting equality and uniformity in surgical treatment.