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Zakko J, Premkumar A, Logan AJ, Sneddon JM, Brock GN, Pawlik TM, Mokadam NA, Whitson BA, Lampert BC, Washburn WK, Osho AA, Ganapathi AM, Schenk AD. Textbook outcome: A novel metric in heart transplantation outcomes. J Thorac Cardiovasc Surg 2024; 167:1077-1087.e13. [PMID: 36990918 DOI: 10.1016/j.jtcvs.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival. METHODS We identified all primary, isolated adult heart transplants in the United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files from May 1, 2005, to December 31, 2017. Textbook outcome was defined as length of stay 30 days or less; ejection fraction greater than 50% during 1-year follow-up; functional status 80% to 100% at 1 year; freedom from acute rejection, dialysis, and stroke during the index hospitalization; and freedom from graft failure, dialysis, rejection, retransplantation, and mortality during the first year post-transplant. Univariate and multivariate analyses were performed. Factors independently associated with textbook outcome were used to create a predictive nomogram. Conditional survival at 1 year was measured. RESULTS A total of 24,620 patients were identified with 11,169 (45.4%, 95% confidence interval, 44.7-46.0) experiencing textbook outcome. Patients with textbook outcome were more likely free from preoperative mechanical support (odds ratio, 3.504, 95% confidence interval, 2.766 to 4.439, P < .001), free from preoperative dialysis (odds ratio, 2.295, 95% confidence interval, 1.868-2.819, P < .001), to be not hospitalized (odds ratio, 1.264, 95% confidence interval, 1.183-1.349, P < .001), to be nondiabetic (odds ratio, 1.187, 95% confidence interval, 1.113-1.266, P < .001), and to be nonsmokers (odds ratio, 1.160, 95% confidence interval,1.097-1.228, P < .001). Patients with textbook outcome have improved long-term survival relative to patients without textbook outcome who survive at least 1 year (hazard ratio for death, 0.547, 95% confidence interval, 0.504-0.593, P < .001). CONCLUSIONS Textbook outcome is an alternative means of examining heart transplant outcomes and is associated with long-term survival. The use of textbook outcome as an adjunctive metric provides a holistic view of patient and center outcomes.
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Affiliation(s)
- Jason Zakko
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - April J Logan
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey M Sneddon
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Guy N Brock
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - William K Washburn
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Austin D Schenk
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Senan S, Schneiders FL, Moghanaki D. Sub-lobar resections for peripheral non-small cell lung cancer measuring ≤ 2 cm: Insights from recent clinical trials. Radiother Oncol 2024; 192:110094. [PMID: 38224918 DOI: 10.1016/j.radonc.2024.110094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/02/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
The findings of two well conducted trials that randomised 1803 patients with a peripheral non-small cell lung cancer measuring ≤ 2 cm to a lobar to sub-lobar resection have established the latter as a new standard of care. It is important for non-surgical oncologists to appreciate the details of study design and outcomes of both studies, given the possible impact they have for considerations of stereotactic ablative radiotherapy (SABR) for operable patients with early-stage NSCLC. Differences in overall survival between the study populations highlight the impact of confounding factors like smoking history and comorbidities on reported outcomes. For example, despite low post-operative mortality rates in both trials, the 5-year disease-free survival rate in the CALGB 140503 trial was only approximately 60 % with either surgical procedure. Both phase III trials required guideline recommended nodal staging, which does not reflect real world surgical practice, and which may limit the generalisability of the reported findings to local institutional outcomes. Furthermore, the emergence of other malignancies was recorded in 15-18 % of study patients during follow-up, and patients who underwent sub-lobar resections had a better long-term survival associated with a higher likelihood of undergoing additional curative treatments. These findings from the JCOG0802 and the CALGB 140503 will encourage more interest in enrolling patients into ongoing trials comparing surgical resection with SABR.
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Affiliation(s)
- Suresh Senan
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands.
| | - Famke L Schneiders
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite #B265, Los Angeles, CA 90095-6951 USA.
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Alnajar A, Razi SS, Kodia K, Villamizar N, Nguyen DM. The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non-small cell lung cancer. JTCVS OPEN 2023; 16:888-906. [PMID: 38204620 PMCID: PMC10775054 DOI: 10.1016/j.xjon.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 01/12/2024]
Abstract
Objectives Textbook oncological outcome (TOO) is a composite metric for surgical outcomes, including non-small cell lung cancer (NSCLC). We hypothesized that social determinants of health (SDH) can affect both the attainment of TOO and the overall survival (OS) in surgically resected NSCLC patients with pathological nodal disease. Methods We queried the National Cancer Database (2010-2017) for preoperative therapy-naïve lobectomies for NSCLC with tumor size <7 cm and pathologic N1/N2. Socioeconomic factors comprised SDH scores, where SDH negative (-) was considered if SDH ≥2 (disadvantage); otherwise, SDH was positive (+). TOO+ was defined as R0 resection, ≥5 lymph nodes resected, hospital stay <75th percentile, no 30-day mortality, adjuvant chemotherapy initiation ≤3 months, and no unplanned readmission. If one of these parameters was not achieved, the case was considered TOO-. Results Of 11,274 patients, 48% of cases were TOO+ and 38% were SDH+. A total of 15% of patients were SDH- and were less likely (adjusted odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92) to achieve TOO+ than patients with SDH+. After accounting for confounders, patients with TOO+ had 22% lower overall mortality than patients with TOO- (adjusted hazard ratio, 0.78; CI, 0.73-0.82). In contrast, SDH- remained an independently significant risk factor, reducing survival by 24% compared with SDH+ (adjusted hazard ratio, 1.24; CI, 1.17-1.32). The impact of SDH on OS was significant for both patients with TOO+ and TOO-: SDH+/TOO+ had the best OS and SDH-/TOO-had the worst OS. Conclusions SDH score has a significant association with TOO achievement and TOO-driven overall posttreatment survival in patients with lobectomy-resected NSCLC with postoperative pathologic N1/N2 nodal metastasis. Addressing SDH is important to optimize care and long-term survival of this patient population.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Syed S. Razi
- Division of Thoracic Surgery, Hackensack Meridian Health, Edison, NJ
| | - Karishma Kodia
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Nestor Villamizar
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Dao M. Nguyen
- Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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Textbook Outcome of Laparoscopic Microwave Ablation for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15020436. [PMID: 36672385 PMCID: PMC9856576 DOI: 10.3390/cancers15020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/28/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
In the context of spreading interest in textbook outcome (TO) evaluation in different fields, we aimed to investigate an uncharted procedure, that is, laparoscopic microwave ablation (MWA) for hepatocellular carcinoma (HCC). Absence of post-MWA complications, a hospital stay of three days, no mortality nor readmission within 30 days, and complete response of the target lesion at post-MWA CT scan defined TO achievement. Patients treated between January 2014 and March 2021 were retrospectively reviewed, and of the 521 patients eligible for the study, 337 (64.7%) fulfilled all the quality indicators to achieve the TO. The absence of complications was the main limiting factor for accomplishing TO. At multivariable analysis, Child-Pugh B cirrhosis, age of more than 70 years old, three nodules, and MELD score ≥ 15 were associated with decreased probabilities of TO achievement. A score based on these factors was derived from multivariable analysis, and patients were divided into three risk groups for TO achievement. At survival analysis, overall survival (OS) was significantly (p = 0.001) higher in patients who achieved TO than those who did not. Moreover, OS evaluation in the three risk groups showed a trend coherent with TO achievement probability. The present study, having assessed the first TO for laparoscopic MWA for HCC, encourages further broader consensus on its definition and, on its basis, on the development of clinically relevant tools for managing treatment allocation.
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Xie GL, Liang L, Ye TW, Xu FQ, Wang DD, Xie YM, Zhang KJ, Fu TW, Yao WF, Liu JW, Zhang CW. The pre- and postoperative nomograms to predict the textbook outcomes of patients who underwent hepatectomy for hepatocellular carcinoma. Front Oncol 2023; 13:1089716. [PMID: 37124507 PMCID: PMC10140493 DOI: 10.3389/fonc.2023.1089716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Background and aims An increasing number of studies have confirmed that non-textbook outcomes (non-TO) are a risk factor for the long-term outcome of malignant tumors. It is particularly important to identify the predictive factors of non-TO to improve the quality of surgical treatment. We attempted to construct two nomograms for preoperative and postoperative prediction of non-TO after laparoscopic hepatectomy for hepatocellular carcinoma (HCC). Methods Patients who underwent curative-intent hepatectomy for HCC between 2014 and 2021 at two Chinese hospitals were analyzed. Using univariate and multivariate analyses, the independent predictors of non-TO were identified. The prediction accuracy is accurately measured by the receiver operating characteristic (ROC) curve and calibration curve. ROC curves for the preoperative and postoperative models, Child-Pugh grade, BCLC staging, and 8th TNM staging were compared relative to predictive accuracy for non-TO. Results Among 515 patients, 286 patients (55.5%) did not achieve TO in the entire cohort. Seven and eight independent risk factors were included in the preoperative and postoperative predictive models by multivariate logistic regression analysis, respectively. The areas under the ROC curves for the postoperative and preoperative models, Child-Pugh grade, BCLC staging, and 8th TNM staging in predicting non-TO were 0.762, 0.698, 0.579, 0.569, and 0.567, respectively. Conclusion Our proposed preoperative and postoperative nomogram models were able to identify patients at high risk of non-TO following laparoscopic resection of HCC, which may guide clinicians to make individualized surgical decisions, improve postoperative survival, and plan adjuvant therapy against recurrence.
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Affiliation(s)
- Gui-Lin Xie
- Department of Hepatobiliary Surgery, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Lei Liang
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Tai-Wei Ye
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fei-Qi Xu
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dong-Dong Wang
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ya-Ming Xie
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kang-Jun Zhang
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tian-Wei Fu
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei-Feng Yao
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jun-Wei Liu
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- *Correspondence: Cheng-Wu Zhang, ; Jun-Wei Liu,
| | - Cheng-Wu Zhang
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- *Correspondence: Cheng-Wu Zhang, ; Jun-Wei Liu,
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Yu WS, Shin J, Son JA, Jung J, Haam S. Assessment of textbook outcome after lobectomy for early‐stage non‐small cell lung cancer in a Korean institution: A retrospective study. Thorac Cancer 2022; 13:1211-1219. [PMID: 35307965 PMCID: PMC9013659 DOI: 10.1111/1759-7714.14391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Textbook outcome (TO) has been introduced as a novel composite measure for lung cancer surgery. We investigated TO after lobectomy for early‐stage non‐small cell lung cancer (NSCLC) in a Korean tertiary hospital and its prognostic implications for overall survival and recurrence. Methods Between January 2012 and December 2017, 418 consecutive patients who underwent lobectomy for clinical stages I and II NSCLC were identified and retrospectively reviewed. TO was defined as complete resection (negative resection margins and sufficient lymph node dissection), no 30‐day or in‐hospital mortality, no reintervention within 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission within 30 days, and no major complications. Propensity score matching analysis was performed to investigate the association between TO, medical costs, and long‐term outcomes. Results Of 418 patients, 277 (66.3%) achieved TO. The most common events leading to TO failure were prolonged air leakage (n = 54, 12.9%) and prolonged hospital stay (n = 53, 12.7%). Male sex (odds ratio [OR] = 2.148, p = 0.036) and low diffusing capacity for carbon monoxide (OR = 0.986, p = 0.047) were significant risk factors for failed TO in multivariate analysis. In matched cohorts, achieving TO was associated with lower medical costs and better overall survival but not cancer recurrence. Conclusions TO is associated with low medical cost and favorable overall survival; thus, surgical teams and hospitals should make efforts to improve the quality of care and achieve TO.
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Affiliation(s)
- Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery Ajou University School of Medicine Suwon Korea
| | - Jaeyong Shin
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea
| | - Jung A Son
- Department of Thoracic and Cardiovascular Surgery Ajou University School of Medicine Suwon Korea
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery Ajou University School of Medicine Suwon Korea
| | - Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery Ajou University School of Medicine Suwon Korea
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Abbas AE. Commentary: Using the National Cancer Database to Create a Surgical Outcomes Composite Index. Is this Textbook or Cliffs Notes? Semin Thorac Cardiovasc Surg 2021; 34:1362-1363. [PMID: 34481045 DOI: 10.1053/j.semtcvs.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Abbas E Abbas
- Division of Thoracic Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, Lifespan Cancer Center and Hospitals, Providence, Rhode Island.
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Denlinger CE. Commentary: Quality vs. conformity. Semin Thorac Cardiovasc Surg 2021; 34:1360-1361. [PMID: 34469798 DOI: 10.1053/j.semtcvs.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022]
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