Department of Obstetrics and Gynaecology, University of Ulm Medical School, Prittwitzstr. 43, 89075 Ulm, Germany.
Department of Obstetrics and Gynaecology, University of Würzburg Medical School, Josef-Schneider-Str. 4, 97080 Würzburg, Germany.
Breast. 2018 Aug;40:54-59. doi: 10.1016/j.breast.2018.04.002. Epub 2018 Apr 23.
Certified multi-disciplinary breast cancer centres (CBCs) have been established worldwide. Development of CBCs, guideline-adherent systemic therapy and surgical management should now show an impact on outcomes. This analysis aimed to investigate whether guideline adherence (GA) rates, relapse-free survival (RFS) and overall survival (OS) have significantly improved at CBCs compared to the pre-certification period.
8323 patients with primary breast cancer were treated in 17 German CBCs, which had been certified between 2003 and 2007 [2003 (n = 1), 2004 (n = 6), 2005 (n = 3), 2006 (n = 6) and 2007 (n = 1)]. 3544 patients (42.6%) were treated before certification and 4779 patients (57.4%) after certification.
A highly significant (p < 0.001) difference in 100%-GA was found between the various hospitals before certification (min 25.0%; max 54.6%). In 2008, when all participating hospitals were certified, the GA rate was 61.8% (min 39.5%, max 74.4%) and 69.2% (min 45.9%, max 86.4%) for patients <75 y (n = 6675). The difference between pre-certification 100%-GA (46.9%) and post-certification (57.2%) was highly significant (p < 0.001). RFS and OS were both significantly better after certification compared to the pre-certification period (RFS: HR = 0.79; 95% CI: 0.68-0.92; p = 0.003; OS: HR = 0.75; 95% CI: 0.65-0.85; p < 0.001). 5-year RFS (OS) of patients <75 y was 89.6% (85.4%) pre-certification and 91.4% (89.5%) post-certification. Since improvement in GA and outcomes correlated as well, GA remains a highly significant prognostic factor for RFS and OS regardless of NPI, intrinsic subtype and adjuvant systemic therapy. This suggests that the certification process is strongly associated with improvements in outcome.
全球已建立了经过认证的多学科乳腺癌中心（CBC）。现在，CBC 的发展、遵循指南的系统治疗和手术管理应该会对结果产生影响。本分析旨在研究与认证前相比，CBC 的指南遵循率（GA）、无复发生存率（RFS）和总生存率（OS）是否显著提高。
在 17 家德国 CBC 中治疗了 8323 名原发性乳腺癌患者，这些 CBC 分别于 2003 年至 2007 年获得认证[2003 年（n=1）、2004 年（n=6）、2005 年（n=3）、2006 年（n=6）和 2007 年（n=1）]。3544 名患者（42.6%）在认证前接受治疗，4779 名患者（57.4%）在认证后接受治疗。
在认证前，各医院之间的 100%-GA 存在显著差异（p<0.001）（最小值为 25.0%；最大值为 54.6%）。2008 年，当所有参与医院都获得认证时，GA 率为 61.8%（最小值为 39.5%，最大值为 74.4%），75 岁以下患者为 69.2%（最小值为 45.9%，最大值为 86.4%）（n=6675）。认证前 100%-GA（46.9%）和认证后的差异具有统计学意义（p<0.001）。与认证前相比，认证后 RFS 和 OS 均显著提高（RFS：HR=0.79；95%CI：0.68-0.92；p=0.003；OS：HR=0.75；95%CI：0.65-0.85；p<0.001）。75 岁以下患者的 5 年 RFS（OS）为认证前 89.6%（85.4%）和认证后 91.4%（89.5%）。由于 GA 和结果的改善呈正相关，因此，无论 NPI、内在亚型和辅助全身治疗如何，GA 仍然是 RFS 和 OS 的一个高度显著的预后因素。这表明认证过程与结果的改善密切相关。
