Merriel Samuel William David, Turner Emma L, Walsh Eleanor, Young Grace J, Metcalfe Chris, Hounsome Luke, Tudge Isobel, Donovan Jenny, Hamdy Freddie, Neal David, Martin Richard M
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Public Health England National Cancer Registration and Analysis Service, Bristol, UK.
BMJ Open. 2017 Nov 14;7(11):e015994. doi: 10.1136/bmjopen-2017-015994.
To compare the completeness and agreement of prostate cancer data recorded by the National Cancer Registration and Analysis Service (NCRAS) with research-level data specifically abstracted from medical records from the Cluster randomised triAl of prostate specific antigen (PSA) testing for Prostate cancer (CAP) trial.
Cross-sectional comparison study.
We included 1356 men from the CAP trial cohort who were linked to the NCRAS registry.
Completeness of prostate cancer data in NCRAS and CAP and agreement for tumour, node, metastases (TNM) stage (T1/T2; T3; T4/N1/M1) and Gleason grade (4-6; 7; 8-10), measured by differences in proportions and Cohen's kappa statistic. Data were also stratified by year and pre-2010 versus post-2010, when NCRAS reporting standards changed.
Compared with CAP, completeness was lower in NCRAS for Gleason grade (41.2% vs 76.7%, difference 35.5, 95% CI 32.1 to 39.0) and TNM stage (29.9% vs 67.6%, difference 37.6, 95% CI 34.1 to 41.1). NCRAS completeness for Gleason grade (pre-2010 vs post-2010 31.69% vs 64%; difference 32.31, 95% CI 26.76 to 37.87) and TNM stage (19.31% vs 55.50%; difference 36.19, 95% CI 30.72 to 41.67) improved over time. Agreement for Gleason grade was high (Cohen's kappa, κ=0.90, 95% CI 0.88 to 0.93), but lower for TNM stage (κ=0.41, 95% CI 0.37 to 0.51) overall. There was a trend towards improved agreement on Gleason grade, but not TNM stage, when comparing pre-2010 and post-2010 data.
NCRAS case identification was very high; however, data on prostate cancer grade was less complete than CAP, and agreement for TNM stage was modest. Although the completeness of NCRAS data has improved since 2010, the higher completeness rate in CAP demonstrates that gains could potentially be achieved in routine registry data. This study's findings highlight a need for improved recording of stage and grade data in the source medical records.
比较国家癌症登记与分析服务中心(NCRAS)记录的前列腺癌数据与专门从前列腺癌特异性抗原(PSA)检测的群组随机试验(CAP)中医疗记录提取的研究级数据的完整性和一致性。
横断面比较研究。
我们纳入了1356名来自CAP试验队列且与NCRAS登记处相关联的男性。
NCRAS和CAP中前列腺癌数据的完整性,以及肿瘤、淋巴结、转移(TNM)分期(T1/T2;T3;T4/N1/M1)和 Gleason分级(4 - 6;7;8 - 10)的一致性,通过比例差异和Cohen's kappa统计量进行测量。数据还按年份以及2010年前与2010年后进行分层,2010年NCRAS报告标准发生了变化。
与CAP相比,NCRAS中Gleason分级的完整性较低(41.2%对76.7%,差异35.5,95%CI 32.1至39.0),TNM分期的完整性也较低(29.9%对67.6%,差异37.6,95%CI 34.1至41.1)。NCRAS中Gleason分级的完整性(2010年前对2010年后31.69%对64%;差异32.31,95%CI 26.76至37.87)和TNM分期的完整性(19.31%对55.50%;差异36.19,95%CI 30.72至41.67)随时间有所改善。Gleason分级的一致性较高(Cohen's kappa,κ = 0.90,95%CI 0.88至0.93),但TNM分期的一致性总体较低(κ = 0.41,95%CI 0.37至0.51)。在比较2010年前和2010年后的数据时,Gleason分级的一致性有改善趋势,但TNM分期没有。
NCRAS的病例识别率非常高;然而,前列腺癌分级数据不如CAP完整,TNM分期的一致性一般。尽管自2010年以来NCRAS数据的完整性有所提高,但CAP中更高的完整性表明常规登记数据仍有提升潜力。本研究结果凸显了在源医疗记录中改善分期和分级数据记录的必要性。