Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Radiation Oncology 2 Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Curr Treat Options Oncol. 2017 Oct 27;18(11):65. doi: 10.1007/s11864-017-0507-8.
In the past few years, several evidences reported better outcomes, in terms of reduced toxicities and longer survival, for head and neck cancer (HNC) patients when "regionalized," namely if they are managed at "high-volume" cancer referral centers (CRC). The benefit of case volume has been demonstrated in HNC patients primarily treated with surgery and in those receiving curative radiotherapy and chemotherapy. Many factors could explain these positive results: organization, facilities, processes of care, quality assurance programs, professional expertise, technology, and patient referral bias. In other words, the "high volume" could be linked both to all hospital-related volume and to the expertise of each involved professional figure (e.g., surgeon, radiation oncologist, medical oncologist, etc.). In this context, it is still debatable whether there is a need to understand which one of these factors is more able to influence the final outcomes of HNC patients. Considering the complexity and heterogeneity of HNC, all of these aspects are likely to impact and plot each other. However, there is no consensus regarding the criteria and the cut-off used to define as "high" the case volume. Moreover, some limitations or biases of the regionalization process have to be highlighted: (1) personal and financial discomfort of patients, their caregivers, and families; (2) a frequent referral of the healthiest or youngest patients to CRC could change the survival outcomes; (3) potential higher difficulties for colleagues working outside of CRC in the emergency. Nevertheless, the case volume represents one of the factors impacting on the quality of the treatment itself, in terms of reduced toxicity and better treatment outcome. Therefore, it should be considered as a stratifying factor in randomized controlled trials for HNC patients.
在过去的几年中，有几项证据表明，对于头颈部癌症（HNC）患者，如果“区域化”，即如果他们在“高容量”癌症转诊中心（CRC）进行管理，那么在降低毒性和延长生存方面会有更好的结果。在主要接受手术治疗的 HNC 患者以及接受根治性放化疗的患者中，已经证明了病例数量的益处。许多因素可以解释这些积极的结果：组织、设施、护理流程、质量保证计划、专业知识、技术和患者转诊偏见。换句话说，“高容量”既与所有与医院相关的容量有关，也与每个相关专业人员（例如外科医生、放射肿瘤学家、肿瘤内科医生等）的专业知识有关。在这种情况下，仍在争论是否有必要了解这些因素中的哪一个更能影响 HNC 患者的最终结果。考虑到头颈部癌症的复杂性和异质性，所有这些方面都可能相互影响。然而，对于定义病例量为“高”的标准和截止值尚未达成共识。此外，还必须强调区域化过程的一些局限性或偏见：（1）患者、其照顾者和家属的个人和经济不适；（2）将最健康或最年轻的患者经常转诊到 CRC 可能会改变生存结果；（3）CRC 以外的同事在紧急情况下可能会遇到更高的困难。然而，病例量是影响治疗本身质量的因素之一，可降低毒性并改善治疗结果。因此，应将其视为 HNC 患者随机对照试验中的分层因素。
