Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA.
Department of Radiation and Cellular Oncology, The University of Chicago, 5758 South Maryland Avenue, M/C 9006, Chicago, IL, 60637, USA.
J Neurooncol. 2017 Dec;135(3):529-534. doi: 10.1007/s11060-017-2598-2. Epub 2017 Aug 23.
The relation between hospital volume and outcomes for patients with glioblastoma is unknown. We undertook this study to determine the effect of hospital volume on treatment received and its effect on survival in patients with glioblastoma. We included patients from the National Cancer Database diagnosed with a glioblastoma from 2006 to 2013. Hospital volume was calculated by examining the treating facilities average number of cases per year and grouping them into tertiles: (low < 9.25, medium 9.26-23.88, and high ≥ 23.39). Treatment was defined as receiving any type of therapeutic surgery, radiation or chemotherapy. Using regression models we examined the relation between hospital volume to treatment received and survival with adjustment for clinical, socioeconomic and institutional factors. The study included 68,726 patients of which 91.8% received treatment. Among patients diagnosed at low volume facilities, 90.1% received treatment versus 94.2% in high volume facilities (p < 0.0001). Compared to low volume centers, the odds ratio of receiving any treatment was 1.01 (CI 95% CI: 0.95-1.09) and 1.43 (95% CI: 1.31-1.55) for medium volume and high volume facilities, respectively. On multivariate analysis for survival among those who received treatment, the hazard of mortality was decreased at high volume (HR 0.92, 95% CI 0.89-0.94) facilities compared to low volume facilities. Patients diagnosed with glioblastoma at a high volume facility (≥23.39 cases per year) have an increased likelihood of receiving treatment. Furthermore, glioblastoma patients may significantly improve their survival by choosing to receive care at a high-volume hospital.
医院容量与胶质母细胞瘤患者结局之间的关系尚不清楚。我们开展此项研究旨在明确医院容量对患者接受治疗的影响及其对生存结局的影响。我们纳入了 2006 年至 2013 年间国家癌症数据库中诊断为胶质母细胞瘤的患者。通过检查治疗机构每年的平均病例数并将其分为三组（低容量组<9.25 例，中容量组 9.26-23.88 例，高容量组≥23.39 例）来计算医院容量。治疗定义为接受任何类型的治疗性手术、放疗或化疗。我们采用回归模型，在校正了临床、社会经济和机构因素后，检验了医院容量与治疗接受情况和生存结局之间的关系。该研究共纳入 68726 例患者，其中 91.8%接受了治疗。在低容量设施诊断的患者中，90.1%接受了治疗，而在高容量设施中这一比例为 94.2%（p<0.0001）。与低容量中心相比，接受任何治疗的比值比分别为 1.01（95%CI：0.95-1.09）和 1.43（95%CI：1.31-1.55）。在接受治疗的患者中，多变量分析显示，与低容量中心相比，高容量中心（HR 0.92，95%CI 0.89-0.94）的死亡风险降低。与低容量中心相比，在高容量中心（≥23.39 例/年）诊断出胶质母细胞瘤的患者接受治疗的可能性更大。此外，选择在高容量医院接受治疗可能会显著提高胶质母细胞瘤患者的生存几率。
