Topic: D. Clinical Cancer
NCI Designation Predicts Improved Outcomes in Colorectal Cancer Surgery
Emily C Paulson, Christopher Wirtalla, Nandita Mitra, Rachel Kelz, Katrina Armstrong, Najjia Mahmoud
Hospital of the University of Pennsylvnia, Philadelphia, PA
The objective of the study is to evaluate the association between NCI cancer center designation and postoperative mortality and long-term survival following colorectal cancer surgery.
We performed a retrospective cohort study of SEER-Medicare database patients undergoing segmental colectomy or proctectomy for cancer from 1996-2003. Multivariate logistic regression, with and without propensity scores, and matched conditional regression were performed to evaluate the relationship between NCI status and postoperative mortality (In-hospital or 30-day death). The log-rank test, Kaplan-Meier curves and Cox regression compared survival between hospital types.
We evaluated 33,970 colectomy and 8,591 proctectomy patients. Postoperative mortality following colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality following proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics (table 1). For both colon and rectal cancer patients, long term mortality was significantly improved following resection at NCI centers (HR .84, p<.001; HR .85, p=.02, respectively) (table 2).
NCI designation is associated with lower risk of postoperative death and improved long-term survival. Possible factors responsible for these benefits include surgeon training, multidisciplinary care and adherence to treatment guidelines. Studies are underway to elucidate the factors leading to improved patient outcomes.
|Multivariate Model OR (p value)|
|Colon||.59 (.009)||.56 (.008)||.55 (.05)|
|Rectal||.50 (.05)||.49 (.05)||.51 (.1)|