Meyerhardt Jeffrey A, Catalano Paul J, Schrag Deborah, Ayanian John Z, Haller Daniel G, Mayer Robert J, Macdonald John S, Benson Al B, Fuchs Charles S
Dana-Farber Cancer Institute, Eastern Cooperative Oncology Group Statistical Center, and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Intern Med. 2003 Oct 21;139(8):649-57. doi: 10.7326/0003-4819-139-8-200310210-00008.
Studies that use registry data have demonstrated superior long-term overall survival after curative surgical resection of colon cancer at hospitals where the volume of such surgeries is high. However, because such administrative data lack information on cancer recurrence, the true nature of this relation remains uncertain.
To determine whether hospital procedure volume predicts long-term outcomes of colon cancer surgery.
Nested cohort study within a randomized clinical trial.
Intergroup 0089 national adjuvant colon cancer study conducted between 1988 and 1992.
3161 patients with high-risk stage II and stage III colon cancer.
Overall survival and recurrence-free survival, by hospital procedure volume as defined by Medicare claims data.
With a median follow-up of 9.4 years, 5-year overall survival significantly differed across tertiles of hospital procedure volume (63.8% for patients who had resection at low-volume hospitals compared with 67.3% at high-volume hospitals; P = 0.04). After adjustment for other predictors of colon cancer outcome, the hazard ratio for overall mortality in patients treated at low-volume centers was 1.16 (95% CI, 1.03 to 1.32). However, the risk for cancer recurrence was not associated with hospital procedure volume. Five-year recurrence-free survival was 63.9% for patients who had resection at low-volume hospitals compared with 63.0% at high-volume hospitals (adjusted hazard ratio, 1.03 [CI, 0.89 to 1.18]). These findings did not materially change after stratification by other potential demographic and clinical predictors of outcome.
According to prospectively recorded data from a large clinical trial, patients whose colon cancer was resected at low-volume hospitals experienced a higher risk for long-term mortality; however, this increased mortality was not attributable to differences in colon cancer recurrences.
利用登记数据进行的研究表明，在结肠癌根治性手术量高的医院，患者术后长期总体生存率更高。然而，由于此类管理数据缺乏癌症复发信息，这种关系的本质仍不确定。
确定医院手术量是否可预测结肠癌手术的长期结局。
随机临床试验中的巢式队列研究。
1988年至1992年进行的0089组国家辅助性结肠癌研究。
3161例高危II期和III期结肠癌患者。
根据医疗保险理赔数据定义的医院手术量，计算总体生存率和无复发生存率。
中位随访9.4年，不同医院手术量三分位数组的5年总体生存率有显著差异（低手术量医院行手术切除的患者为63.8%，高手术量医院为67.3%；P = 0.04）。在对其他结肠癌结局预测因素进行调整后，低手术量中心治疗患者的总体死亡风险比为1.16（95%CI，1.03至1.32）。然而，癌症复发风险与医院手术量无关。低手术量医院行手术切除的患者5年无复发生存率为63.9%，高手术量医院为63.0%（调整后风险比，1.03[CI，0.89至1.18]）。按其他潜在的人口统计学和临床结局预测因素分层后，这些结果没有实质性变化。
根据一项大型临床试验的前瞻性记录数据，在低手术量医院接受结肠癌切除术的患者长期死亡风险更高；然而，这种死亡率增加并非归因于结肠癌复发的差异。
