Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique, 55, B-1000 Brussels, Belgium.
Breast. 2012 Jun;21(3):261-6. doi: 10.1016/j.breast.2011.12.002. Epub 2011 Dec 26.
To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators.
Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and ≥ 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage.
A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals.
Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.
基于 11 个经过验证的过程质量指标，比较比利时不同医院容量的乳腺癌治疗过程和生存情况。
在患者层面上对三个数据库进行了链接：癌症登记处、人口和索赔数据库。选择了 2004 年至 2006 年间患有浸润性乳腺癌的所有女性。根据每年治疗患者的数量对医院进行分类：<50（极低），50-99（低），100-149（中）和≥150（高）。使用 Cox 和逻辑回归模型来测试不同容量类别之间 5 年生存率和实现过程指标的差异，调整了年龄、肿瘤分级和分期。
共有 25178 名患有浸润性乳腺癌的女性在 111 家医院接受治疗。一半的医院（N=57）每年治疗的患者<50 人。在 11 个过程指标中有 6 个在高容量医院中显示出更高的比率：多学科团队会议、手术前细胞学和/或组织学评估、新辅助化疗的使用、保乳手术率、保乳手术后辅助放疗和随访乳房 X 线检查。更高的容量也与生存率的提高有关。在极低、低、中、高容量医院治疗的患者的 5 年观察生存率分别为 74.9%、78.8%、79.8%和 83.9%。经过病例组合调整后，与高容量医院相比，极低或低容量医院治疗的患者死亡风险比分别为 1.26（95%CI 1.12, 1.42）和 1.15（95%CI 1.01, 1.30）。
高容量医院报告的生存获益表明，更好地应用了推荐的治疗过程，这证明了在这些医院集中进行乳腺癌治疗是合理的。
Zotero 插件