OBJECTIVE To determine if cancer patients experience variability in incidence or management of emergency general surgery (EGS) conditions compared to non-cancer patients. BACKGROUND The true frequency, and natural history of EGS conditions among cancer patients has not been characterized. METHODS We utilized SEER-Medicare data from January 2006-December 2015 to compare patients with breast, prostate, and lung cancer to a non-cancer cohort. Patients were followed from date of cancer diagnosis, or an index date for non-cancer patients, to the development of an EGS condition, death or last follow up. We assessed the cumulative incidence of EGS conditions over time, and fit multivariable Cox proportional hazards models to evaluate the impact of time-dependent surgical intervention on mortality. RESULTS We identified 322,756 patients with breast (N=82,147), lung (N=128,618), and prostate cancer (N=111,991) and 210,429 non-cancer patients.. Cancer patients had a higher incidence of an EGS condition within the first year after diagnosis (4.8% vs. 3.2%), with lung (6.8%) and breast cancer (4.0%) showing consistent rends. Cancer patients were less likely to undergo surgery for (13% vs. 14%, P=0.005), though this varied by cancer type and EGS conditions. Patients with breast (HR 1.27, 95%CI 1.17-1.39) and lung cancer (HR 3.27, 95%CI 3.07-3.48) were more likely to die within 30-days of an EGS diagnosis. CONCLUSIONS Cancer patients experience a higher incidence of EGS conditions within the first year following diagnosis, but are less likely to undergo surgery. Future research is needed to explore the interplay between EGS conditions, their management, and receipt of intended oncologic therapy, and resulting outcomes.

中文翻译：

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癌症患者紧急普通外科病症的频率和自然史：SEER-Medicare 人群分析。


目的 确定与非癌症患者相比，癌症患者在紧急普通外科 （EGS） 病症的发生率或管理方面是否存在差异。背景 癌症患者 EGS 状况的真实频率和自然病程尚未确定。方法 我们利用 2006 年 1 月至 2015 年 12 月的 SEER-Medicare 数据将乳腺癌、前列腺癌和肺癌患者与非癌症队列进行比较。从癌症诊断日期或非癌症患者的索引日期，到 EGS 病情的发展、死亡或最后一次随访，对患者进行随访。我们评估了 EGS 病症随时间推移的累积发生率，并拟合多变量 Cox 比例风险模型以评估时间依赖性手术干预对死亡率的影响。结果 我们确定了 322,756 例乳腺癌 （N=82,147）、肺癌 （N=128,618） 和前列腺癌 （N=111,991） 患者和 210,429 例非癌症患者。癌症患者在诊断后第一年内 EGS 病症的发生率较高 （4.8% vs. 3.2%），肺癌 （6.8%） 和乳腺癌 （4.0%） 表现出一致的复发。癌症患者接受手术的可能性较小 （13% vs. 14%，P=0.005），尽管这因癌症类型和 EGS 条件而异。乳腺癌 （HR 1.27,95% CI 1.17-1.39） 和肺癌 （HR 3.27,95% CI 3.07-3.48） 患者更有可能在 EGS 诊断后 30 天内死亡。结论 癌症患者在诊断后第一年内 EGS 病症的发生率较高，但接受手术的可能性较小。需要进一步的研究来探索 EGS 疾病、其管理和接受预期的肿瘤治疗以及由此产生的结果之间的相互作用。