加利福尼亚州国立癌症研究所指定癌症中心治疗急性髓系白血病与早期死亡率降低相关。
Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.
机构信息
Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, California.
Department of Hematology Oncology, Kaiser Permanente North Valley, Sacramento, California.
出版信息
Cancer. 2018 May 1;124(9):1938-1945. doi: 10.1002/cncr.31296. Epub 2018 Feb 16.
BACKGROUND
To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML).
METHODS
Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis).
RESULTS
Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs.
CONCLUSIONS
The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society.
背景
据作者所知，迄今为止，很少有基于人群的研究评估过急性髓细胞白血病（AML）患者的治疗地点、诱导治疗并发症与早期死亡率之间的关系。
方法
作者利用加利福尼亚癌症登记处和患者出院数据集（1999-2014 年）中的关联数据，确定了在诊断后 30 天内接受住院治疗的成年（年龄≥18 岁）AML 患者。创建了国立癌症研究所指定癌症中心（NCI-CC）治疗的倾向评分。使用逆概率加权、多变量逻辑回归模型来确定治疗地点、并发症与早期死亡率（诊断后≤60 天内死亡）之间的关系。
结果
在 7007 例 AML 患者中，有 1762 例（25%）在 NCI-CC 接受治疗。在 NCI-CC 接受治疗的 AML 患者更可能年龄≤65 岁，居住在社会经济地位较高的社区，合并症较少，且有公共医疗保险。在 NCI-CC 接受治疗的患者肾衰竭发生率较高（23%比 20%；P=0.010），呼吸衰竭发生率较低（11%比 14%；P=0.003），心搏骤停发生率较低（1%比 2%；P=0.014）。在调整基线特征后，NCI-CC 治疗与早期死亡率较低相关（比值比，0.46；95%置信区间，0.38-0.57）。除了在非 NCI-CC 接受治疗的呼吸衰竭患者中观察到的早期死亡率较高外，并发症对早期死亡率的影响不因治疗地点而异。
结论
与非 NCI-CC 治疗相比，NCI-CC 治疗初治成年 AML 患者的早期死亡率降低了 53%。较低的早期死亡率可能是由于医院或提供者经验和支持性护理的差异所致。癌症 2018；124:1938-45。©2018 美国癌症协会。
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