Lewis Carol M, Nurgalieva Zhannat, Sturgis Erich M, Lai Stephen Y, Weber Randal S
Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Head Neck. 2016 Apr;38 Suppl 1:E1820-5. doi: 10.1002/hed.24325. Epub 2015 Dec 22.
The purpose of this study was for us to determine National Comprehensive Cancer Network (NCCN) guideline-compliance of multidisciplinary conference (MDC) recommendations and actual treatment received, and to determine this impact on patient outcomes.
We conducted a retrospective review of patients presented at MDC between January 1, 2006, and December 31, 2006, with previously untreated incident cancers.
We identified 232 patients, for whom MDC recommendations were NCCN guideline-compliant in 201 (86.6%). Actual treatment was NCCN guideline-compliant in 170 of 197 patients (86.3%). Adherence of MDC recommendations to NCCN guidelines was associated with superior overall survival (hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.33-1.39; p = .3), as was guideline-compliance of actual treatment (HR = 0.6; 95% CI = 0.64-1.07; p = .07); congruence between MDC recommendations and actual treatment conferred a statistically significant overall survival benefit (HR = 0.49; 95% CI = 0.27-0.89; p = .02).
Our findings argue for patient-centered application of NCCN guidelines. Prospective evaluation will enable more timely identification of systematic NCCN guideline deviations that quality improvement interventions may address. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1820-E1825, 2016.
本研究的目的是确定多学科会议(MDC)建议符合美国国立综合癌症网络(NCCN)指南的情况以及实际接受的治疗情况,并确定这对患者预后的影响。
我们对2006年1月1日至2006年12月31日期间在MDC就诊的既往未接受过治疗的新发癌症患者进行了回顾性研究。
我们确定了232例患者,其中201例(86.6%)的MDC建议符合NCCN指南。197例患者中有170例(86.3%)的实际治疗符合NCCN指南。MDC建议符合NCCN指南与更好的总生存期相关(风险比[HR]=0.69;95%置信区间[CI]=0.33 - 1.39;p = 0.3),实际治疗符合指南情况也是如此(HR = 0.6;95% CI = 0.64 - 1.07;p = 0.07);MDC建议与实际治疗的一致性带来了具有统计学意义的总生存期获益(HR = 0.49;95% CI = 0.27 - 0.89;p = 0.02)。
我们的研究结果支持以患者为中心应用NCCN指南。前瞻性评估将有助于更及时地识别质量改进干预措施可能解决的系统性NCCN指南偏差。© 2015威利期刊公司。《头颈》38:E1820 - E1825,2016年。