Bristow Robert E, Chang Jenny, Ziogas Argyrios, Campos Belinda, Chavez Leo R, Anton-Culver Hoda
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine - School of Medicine, Irvine, CA.
Department of Epidemiology, University of California, Irvine - School of Medicine, Irvine, CA.
J Am Coll Surg. 2015 May;220(5):940-50. doi: 10.1016/j.jamcollsurg.2015.01.056. Epub 2015 Feb 14.
The regional impact of care at a National Cancer Institute Comprehensive Cancer Center (NCI-CCC) on adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines and survival is unclear.
We performed a retrospective population-based study of consecutive patients diagnosed with epithelial ovarian cancer between January 1, 1996 and December 31, 2006 in southern California. Patients were stratified according to care at an NCI-CCC (n = 5), non-NCI high-volume hospital (≥ 10 cases/year, HVH, n = 29), or low-volume hospital (<10 cases/year, LVH, n = 158). Multivariable logistic regression and Cox-proportional hazards models were used to examine the effect of NCI-CCC status on treatment guideline adherence and ovarian cancer-specific survival.
A total of 9,933 patients were identified (stage I, 22.8%; stage II, 7.9%; stage III, 45.1%; stage IV, 24.2%), and 8.1% of patients were treated at NCI-CCCs. Overall, 35.7% of patients received NCCN guideline adherent care, and NCI-CCC status (odds ratio [OR] 1.00) was an independent predictor of adherence to treatment guidelines compared with HVHs (OR 0.83, 95% CI 0.70 to 0.99) and LVHs (OR 0.56, 95% CI 0.47 to 0.67). The median ovarian cancer-specific survivals according to hospital type were: NCI-CCC 77.9 (95% CI 61.4 to 92.9) months, HVH 51.9 (95% CI 49.2 to 55.7) months, and LVH 43.4 (95% CI 39.9 to 47.2) months (p < 0.0001). National Cancer Institute Comprehensive Cancer Center status (hazard ratio [HR] 1.00) was a statistically significant and independent predictor of improved survival compared with HVH (HR 1.18, 95% CI 1.04 to 1.33) and LVH (HR 1.30, 95% CI 1.15 to 1.47).
National Cancer Institute Comprehensive Cancer Center status is an independent predictor of adherence to ovarian cancer treatment guidelines and improved ovarian cancer-specific survival. These data validate NCI-CCC status as a structural health care characteristic correlated with superior ovarian cancer quality measure performance. Increased access to NCI-CCCs through regional concentration of care may be a mechanism to improve clinical outcomes.
国立癌症研究所综合癌症中心（NCI - CCC）的护理对遵循国立综合癌症网络（NCCN）卵巢癌治疗指南及生存的区域影响尚不清楚。
我们对1996年1月1日至2006年12月31日在南加利福尼亚连续诊断为上皮性卵巢癌的患者进行了一项基于人群的回顾性研究。患者根据在NCI - CCC（n = 5）、非NCI的高容量医院（≥10例/年，H VH，n = 29）或低容量医院（<10例/年，LVH，n = 158）接受的护理进行分层。使用多变量逻辑回归和Cox比例风险模型来检验NCI - CCC状态对治疗指南遵循情况和卵巢癌特异性生存的影响。
共识别出9933例患者（I期，22.8%；II期，7.9%；III期，45.1%；IV期，24.2%），8.1%的患者在NCI - CCC接受治疗。总体而言，35.7%的患者接受了符合NCCN指南的护理，与H VH（比值比[OR] 0.83，95%可信区间0.70至0.99）和LVH（OR 0.56，95%可信区间0.47至0.67）相比，NCI - CCC状态（OR 1.00）是治疗指南遵循情况的独立预测因素。根据医院类型，卵巢癌特异性生存的中位数分别为：NCI - CCC 77.9（95%可信区间61.4至92.9）个月，H VH 51.9（95%可信区间49.2至55.7）个月，LVH 43.4（95%可信区间39.9至47.2）个月（p < 0.0001）。与H VH（风险比[HR] 1.18，95%可信区间1.04至1.33）和LVH（HR 1.30，95%可信区间1.15至1.47）相比，国立癌症研究所综合癌症中心状态（HR 1.00）是生存改善的统计学显著且独立的预测因素。
国立癌症研究所综合癌症中心状态是遵循卵巢癌治疗指南及改善卵巢癌特异性生存的独立预测因素。这些数据证实NCI - CCC状态是与卓越的卵巢癌质量指标表现相关的结构性医疗保健特征。通过区域集中护理增加对NCI - CCC的可及性可能是改善临床结局的一种机制。
