Department of Radiation Oncology, China Medical University Hospital School of Medicine, China.
Clin Otolaryngol. 2011 Dec;36(6):558-65. doi: 10.1111/j.1749-4486.2011.02405.x.
The relationship between physician case volume and patient outcome in patients with head and neck cancers such as nasopharyngeal carcinoma treated by radiotherapy is unknown. This study was designed to investigate the association between the case volume of radiation oncologists and the survival of patients with nasopharyngeal carcinoma.
Retrospective cohort study.
Based on nationwide claims data (National Health Research Insurance Database) in the years 2002-2008.
Newly diagnosed patients with nasopharyngeal carcinoma receiving curative radiotherapy in the year 2003.
Overall survival until 2008. We used the running log-rank test to decide the optimal threshold for categorising the case volume of radiation oncologists. The characteristics of patients, their treatments and contact with health service providers were considered as co-explanatory variables. The log-rank test and Cox regression were performed. Sensitivity analyses were carried out regarding major study assumptions.
Five hundred and sixty-two patients with nasopharyngeal carcinoma newly diagnosed in 2003 were identified as the study cohort. The 5-year overall survival was better among patients treated by high-volume (≥6 patients in year 2002) radiation oncologists than by low-volume (<6 patients in year 2002) radiation oncologists (77%versus 64%, P = 0.0007). The adjusted hazard ratio of death was 0.65 (95% confidence interval, 0.48-0.91) upon multivariate analysis. Patients aged at least 65 years also had a lower survival rate than those younger than 65 years old (adjusted hazard ratio of death: 2.81, 95% confidence interval: 1.94-4.08).The physician case volume and patient outcome effect remained the same after sensitivity analyses.
Patients with nasopharyngeal carcinoma treated by high-volume radiation oncologists have better survival compared with those treated by low-volume radiation oncologists. Further studies are needed to verify our findings with similar cancer cohorts treated by modern radiotherapy techniques or other types of radiotherapy.
在接受放射治疗的头颈部癌症（如鼻咽癌）患者中，医生的病例量与患者预后之间的关系尚不清楚。本研究旨在探讨放射肿瘤学家的病例量与鼻咽癌患者生存之间的关系。
回顾性队列研究。
基于 2002-2008 年的全国索赔数据（国家健康研究保险数据库）。
2003 年接受根治性放射治疗的新诊断为鼻咽癌的患者。
截至 2008 年的总生存率。我们使用运行对数秩检验来确定分类放射肿瘤学家病例量的最佳阈值。患者的特征、治疗方法和与卫生服务提供者的接触被视为协变量。进行对数秩检验和 Cox 回归。针对主要研究假设进行了敏感性分析。
确定了 562 例 2003 年新诊断为鼻咽癌的患者作为研究队列。与低病例量（2002 年每年<6 例）放射肿瘤学家相比，高病例量（2002 年每年≥6 例）放射肿瘤学家治疗的患者 5 年总生存率更高（77%对 64%，P=0.0007）。多变量分析时，死亡的调整风险比为 0.65（95%置信区间，0.48-0.91）。年龄至少 65 岁的患者的生存率也低于 65 岁以下的患者（死亡的调整风险比：2.81，95%置信区间：1.94-4.08）。敏感性分析后，医生病例量和患者预后的影响仍然相同。
与低病例量放射肿瘤学家相比，高病例量放射肿瘤学家治疗的鼻咽癌患者的生存率更高。需要进一步的研究来验证我们的发现，包括使用现代放射治疗技术或其他类型的放射治疗治疗的类似癌症队列。
