Are all high-volume surgeons equally good outcome? A survival analysis of patients with oral cavity squamous cell carcinoma in relation to surgical margin status based on propensity score matching analysis

Author:

Kang Chung-Jan1,Wen Yu-Wen2,Chien Chih-Yen3,Lee Shu-Ru2,Ng Shu-Hang1,Lee Li-Yu1,Lin Jin-Ching4,Wang Cheng Ping5,Terng Shyuang-Der6,Hua Chun-Hung7,Chen Tsung-Ming8,Chen Wen-Cheng9,Tsai Yao-Te9,Tsai Chi-Ying1,Lin Chien-Yu9,Fan Kang-Hsing9,Wang Hung-Ming1,Hsieh Chia-Hsun1,Yeh Chih-Hua1,Lin Chih-Hung10,Tsao Chung-Kan10,Cheng Nai-Ming1,Fan Tuan-Jen1,Huang Shiang-Fu1,Lee Li-Ang1,Fang Ku-Hao1,Wang Yu-Chien1,Lin Wan-Ni1,Hsin Li-Jen1,Yen Tzu-Chen1,Liao Chun-Ta1

Affiliation:

1. Chang Gung Memorial Hospital, Chang Gung University

2. Chang Gung University

3. Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine

4. Changhua Christian Hospital

5. National Taiwan University Hospital and College of Medicine

6. Koo Foundation Sun Yat-Sen Cancer Center

7. China Medical University Hospital

8. Shuang Ho Hospital, Taipei Medical University

9. Chang Gung Memorial Hospital

10. Chang Gung Memorial Hospital and Chang Gung University

Abstract

Abstract Background In this retrospective study, we assessed whether Taiwanese high-volume surgeons performing oral cavity squamous cell carcinoma (OCSCC) removal may differ in terms of margin status, and examined how this variable – as a quality standard – could have an impact on clinical outcomes after adjustment for clinicopathological risk factors and treatment modalities. Methods On analyzing a nationwide dataset, margins < 5 mm (including positive margins) were identified in 49.5% (6927/13984) of patients with OCSCC. We subsequently identified the surgeon with the highest absolute volume (number of operated patients = 560), who was located below the mean value (49.5%). Among surgeons above the mean, we identified the two surgeons with the highest volumes (termed as Surgeon 2 and Surgeon 3). The number of patients and survival operated by Surgeon 2 and Surgeon 3 were similar (number 229 and 221, respectively, totaling 450 patients; 5-year overall survivals [OSs] 64% and 65%, respectively) and thus they were grouped together for the purpose of analysis (Surgeons 2–3). Results The patient proportion of margins ≥ 5 mm was markedly higher in Surgeon 1 than Surgeons 2 − 3 (75.4% and 22.5%, respectively). Compared to Surgeons 2 − 3, the tumor severity was higher in Surgeon 1 (mainly a higher frequency of pT4a status, p-Stage IV, and poorly differentiated tumor). The clinical outcomes of patients treated by Surgeon 1 were more favorable than those treated by Surgeons 2 − 3 and these survival differences were even more pronounced after adjusting for baseline differences using propensity score matching (before propensity score: disease-specific survival [DSS], 83%/70%, p < 0.0001; OS, 77%/64%, p < 0.0001; after propensity score: DSS, 87%/68%, p < 0.0001; OS, 81%/63%, p < 0.0001). When patients were stratified according to the operating surgeon and margin status, we found that Surgeon 1 consistently outperformed Surgeons 2 − 3 in terms of clinical outcomes, regardless of surgical margin status (i.e., ≥ 5 mm, < 5 mm, and positive margins). Conclusions We conclude that the achievement of clear margins (≥ 5 mm) is a surgeon-dependent variable which is not necessarily related to hospital and/or surgeon volumes, therefore surgeons should strive to achieve adequate margins to optimize survival in OCSCC.

Publisher

Research Square Platform LLC

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3