Department of Research, Comprehensive Cancer Centre The Netherlands, PO Box 19079, 3501 DB Utrecht, The Netherlands.
Breast Cancer Res Treat. 2012 Jan;131(2):691-8. doi: 10.1007/s10549-011-1809-3. Epub 2011 Oct 11.
Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% 'focally positive' or 'more than focally positive' for DCIS and 10% 'more than focally positive' for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5-31.4%) of DCIS and 9.1% (95% CI: 8.4-9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts.
荷兰将首次保乳手术后的切缘状态用作乳腺癌治疗质量的指标。本研究旨在描述各医院间切缘状态的差异。从荷兰癌症登记处中选择了 7345 例于 2008 年 7 月 1 日至 2009 年 6 月 30 日期间被诊断为 DCIS 或浸润性癌（T1-2，N0-1，M0）并接受首次保乳手术的患者。患者在 96 家医院接受治疗。DCIS 的最大目标值为 30%“局灶阳性”或“局灶以上阳性”，浸润性癌的最大目标值为 10%“局灶以上阳性”。各医院的结果以漏斗图呈现。对于浸润性癌，采用多变量逻辑回归对病例组合进行校正。总体而言，28.5%（95%CI：25.5-31.4%）的 DCIS 和 9.1%（95%CI：8.4-9.8%）的浸润性癌有阳性切缘。医院间的差异很大。分别有 6 家和 10 家医院的 DCIS 和浸润性癌百分比超过了一致性上限。病例组合校正后，有 5 家医院的结论显著不同。校正病例组合后，有 10 家医院的阳性率显著升高，而有 7 家医院的阳性率显著降低。高阳性率与乳腺癌患者数量或医院类型（教学医院与非教学医院）无关。高阳性率与旨在选择保乳手术而非乳房切除术的医院相关。荷兰的阳性切缘总体百分比在预定目标内。医院间的差异很大，但主要可以用偶然因素来解释。病例组合校正会导致相关的变化。
