Woldu Solomon L, Matulay Justin T, Clinton Timothy N, Singla Nirmish, Krabbe Laura-Maria, Hutchinson Ryan C, Sagalowsky Arthur, Lotan Yair, Margulis Vitaly, Bagrodia Aditya
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Urology, Columbia University Medical Center, New York, NY.
Urol Oncol. 2018 Jan;36(1):14.e7-14.e15. doi: 10.1016/j.urolonc.2017.08.024. Epub 2017 Sep 19.
Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns.
The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95-99th percentile, 14.6-26.0 cases annually), intermediate (75-95th percentile, 6.1-14.5 cases annually), low-intermediate (25-75th percentile, 1.8-6.0 cases annually), and low (25th percentile,<1.8 cases annually). The median (interquartile range) number of TGCT cases per institution per year was 3.4 (1.8-6.1).
A total of 33,417 patients with TGCT diagnosed from 1,239 institutions met inclusion criteria. Despite worse disease characteristics of patients treated at higher volume institutions, hospital volume was positively associated with survival outcomes in more advanced cases of TGCT. In the overall cohort, compared to the high-volume hospitals, patients treated at high-intermediate, intermediate, low-intermediate, and low volume hospitals the hazard ratio for overall mortality was 1.28, 1.45, 1.48, and 1.83, respectively (P<0.05). The association between survival and hospital volume was not apparent for seminoma or stage I NSGCT. Patients treated at higher volume hospitals were more likely to undergo surveillance for stage I seminoma, primary retroperitoneal lymph node dissection (RPLND) for stage I NSGCT, and postchemotherapy RPLND for stage II/III NSGCT.
Our analysis of a nationwide cancer registry demonstrated that increased hospital TGCT case volume was associated with significant differences in management strategies and improved survival outcomes, in particular for more advanced disease.
鉴于睾丸生殖细胞肿瘤（TGCT）的罕见性以及管理方面的复杂性，我们评估了医院TGCT病例数量对总体生存结果和实践模式的影响。
查询国家癌症数据库中诊断为精原细胞瘤或非精原细胞性生殖细胞肿瘤（NSGCT）的患者。医院按病例数量分类为高（第99百分位数，每年≥26.1例）、高中间（第95 - 99百分位数，每年14.6 - 26.0例）、中间（第75 - 95百分位数，每年6.1 - 14.5例）、低中间（第25 - 75百分位数，每年1.8 - 6.0例）和低（第25百分位数，每年<1.8例）。每个机构每年TGCT病例的中位数（四分位间距）为3.4（1.8 - 6.1）。
共有来自1239家机构的33417例诊断为TGCT的患者符合纳入标准。尽管在病例数量较多的机构接受治疗的患者疾病特征较差，但在更晚期的TGCT病例中，医院病例数量与生存结果呈正相关。在整个队列中，与高病例数量医院相比，在高中间、中间、低中间和低病例数量医院接受治疗的患者总体死亡风险比分别为1.28、1.45、1.48和1.83（P<0.05）。对于精原细胞瘤或I期NSGCT，生存与医院病例数量之间的关联不明显。在病例数量较多的医院接受治疗的患者更有可能对I期精原细胞瘤进行监测，对I期NSGCT进行原发性腹膜后淋巴结清扫（RPLND），对II/III期NSGCT进行化疗后RPLND。
我们对全国癌症登记处的分析表明，医院TGCT病例数量的增加与管理策略的显著差异和生存结果的改善相关，特别是对于更晚期的疾病。
