Abstract
ObjectiveQuality assurance is crucial for oncological surgical treatment assessment. For rare diseases, single-quality indicators are not enough. We aim to develop a comprehensive and reproducible measurement, called the “Textbook Outcome” (TO), to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma (G-NEC) patients.MethodsData from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed. TO included receiving a curative resection, ≥15 lymph nodes examined, no severe postoperative complications, hospital stay ≤21 d, and no hospital readmission ≤30 d after discharge. Hospital variation in TO was analyzed using a case mix-adjusted funnel plot. Prognostic factors of survival and risk factors for non-Textbook Outcome (non-TO) were analyzed using Cox and logistic models, respectively.ResultsTO was achieved in 56.6% of 860 G-NEC patients. TO patients had better overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) than non-TO patients (P<0.05). Moreover, TO patients accounted for 60.3% of patients without recurrence. Multivariate Cox analysis revealed non-TO as an independent risk factor for OS, DFS, and RFS of G-NEC patients (P<0.05). Increasing TO rates were associated with improved OS for G-NEC patients, but not hospital volume. Multivariate logistic regression revealed that non-lower tumors, open surgery, and >200 mL blood loss were independent risk factors for non-TO patients (P<0.05).ConclusionsTO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients. Factors predicting non-TO are identified, which may help guide strategies to optimize G-NEC outcomes.
Highlights
Gastric cancer (GC) is the second most common malignant tumor and the third cause of cancer-related deaths [1,2]
This study aimed to collect the clinical data of GNEC patients from 24 Chinese hospitals, to carry out the first multicenter study revealing the value of Textbook Outcome (TO) for this rare disease
Baseline characteristics for the TO and non-Textbook Outcome (non-TO) groups are presented in Supplementary Table S1
Summary
Gastric cancer (GC) is the second most common malignant tumor and the third cause of cancer-related deaths [1,2]. For more common types of tumors, such as GC, some major clinical centers may deal with numerous cases in a short time [6]. In 2013, Kolfschoten et al [10] first proposed the composite index of “Textbook Outcome (TO)”, whose value has been gradually recognized in the assessment of care quality and prognosis of common tumors. Given its combination of available short-term data, including radical resection, number of lymph node dissections, postoperative complications, postoperative hospital stay, and postoperative readmission, TO is technically more suitable as an index of surgical quality control for rare diseases. This study aimed to collect the clinical data of GNEC patients from 24 Chinese hospitals, to carry out the first multicenter study revealing the value of TO for this rare disease. We hope to provide a tool to evaluate surgical quality systematically, improve the standards of surgical treatment, and guide clinical practice about the best care resources
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