理解末期使用侵入性手术（IPs）的情况对于避免低治疗和过度治疗非常重要，但流行病学分析受到限定性方法无法定义治疗意图和末期阶段的阻碍。本研究应用了新颖的方法来报告结直肠癌（CRC）病例研究中末期使用的IPs。使用了2013-2015年间诊断的英国人口群体的成年患者队列，并进行了2018年的随访。两位外科医生独立进行了癌症部位和诊断阶段的手术意图（治愈性、非治愈性、诊断性）的分类。联结点回归模型对36个分组的患者进行了0-36个月存活时间增量的每周IPs率建模。在死亡前的一个显著IPs率变化定义了末期阶段。零膨胀泊松回归探索了IPs率与临床/社会人口学变量之间的关联。 在本研究中，共纳入了87,731名患者，其中41,972名（48%）死亡。9,492个手术按照意图进行了分类（评估者间一致性为99.8%）。患者接受了502,895次IPs（存活者每人年1.39次，死亡者每人年3.36次）。联结点回归分析发现在生存3-6个月的患者死亡前4周IPS显著增加，并且在生存7-36个月的患者死亡前8周IPS显著增加。共有7,908名（18.8%）患者在末期接受了IPs，其中造口术是最常见的重大手术。年龄较小、早期阶段疾病、男性、较低共患病率、接受化疗和诊断后生存时间较长的患者与IPS相关。 开发并在CRC人群中测试了鉴别和分类末期IPs的方法。现在可以扩展和验证此方法以鉴别潜在的低治疗和过度治疗。Copyright © 2023 Elsevier Inc. 出版

Understanding the use of invasive procedures (IPs) at the end-of-life (EoL) is important to avoid under- and overtreatment, but epidemiologic analysis is hampered by limited methods to define treatment intent and EoL phase. This study applied novel methods to report IPs at the EoL using a colorectal cancer (CRC) case study.An English population-based cohort of adult patients diagnosed between 2013-2015 was used with follow-up to 2018. Procedure intent (curative, non-curative, diagnostic) by cancer site and stage at diagnosis was classified by two surgeons independently. Joinpoint regression modelled weekly rates of IPs for 36 sub-cohorts of patients with incremental survival of 0-36 months. EoL phase was defined by a significant IP rate change before death. Zero-inflated Poisson regression explored associations between IP rates and clinical/sociodemographic variables.Of 87,731 patients included, 41,972 (48%) died. 9,492 procedures were classified by intent (interrater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36 per person year for survivors and decedents). Joinpoint regression identified significant increases in IPs four weeks before death in those living 3-6 months, and eight weeks before death in those living 7-36 months from diagnosis. 7,908 (18.8%) patients underwent IPs at the EoL, with stoma formation the most common major procedure. Younger age, early-stage disease, men, lower comorbidity, those receiving chemotherapy and living longer from diagnosis were associated with IPs.Methods to identify and classify IPs at the EoL were developed and tested within a CRC population. This approach can be now extended and validated to identify potential under- and overtreatment.Copyright © 2023. Published by Elsevier Inc.