Department of Information Technology and Management, The National Center of Child Health and Development, Japan.
Children's Cancer Center, The National Center of Child Health and Development, Japan.
Eur J Cancer. 2019 Mar;109:111-119. doi: 10.1016/j.ejca.2018.12.030. Epub 2019 Feb 1.
Paediatric brain tumours are the second most common type of malignancies that occur during childhood. Surgical resection is usually the first step in the treatment of these patients; however, evidence pertaining to a 'volume effect' in paediatric brain tumour resection surgery and the associations among the surgical volume, clinical features and treatments are not well characterised.
Data pertaining to paediatric patients (age ≤ 15 years) who underwent brain tumour resection surgery between April 2012 and March 2016 were retrieved from the Japanese administrative inpatient database and retrospectively analysed. Demographic characteristics, therapeutic procedures and in-hospital mortality were summarised according to the hospital surgical volume. Penalised logistic regression analysis was used to investigate the association between the hospital surgical volume and in-hospital mortality.
A total of 1354 paediatric patients were included. About 40% of the patients were in the 11- to 15-year age group. The male:female ratio was 53:47, the overall crude in-hospital mortality was 1.8% (n = 24) and the 30-day postoperative mortality was 0.4% (n = 6). The crude mortality ratio was 3.3% in the lowest quartile and 0.8% in the highest quartile by volume. After adjusting for covariates, a higher hospital surgical volume was associated with lower in-hospital mortality (compared with 1-4 surgeries per 4 years, 15-25 surgeries, odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.05-0.90, p = 0.033; ≥26 surgeries, OR: 0.31; 95% CI: 0.08-0.96, p = 0.042).
The present study indicated a volume-outcome relationship in paediatric brain tumour resection surgery cases. Further centralisation of surgeries should be considered to achieve better outcomes.
小儿脑瘤是儿童时期第二常见的恶性肿瘤。手术切除通常是这些患者治疗的第一步；然而，小儿脑瘤切除术的“体积效应”以及手术量、临床特征和治疗之间的关联证据尚未得到充分描述。
从日本行政住院数据库中检索了 2012 年 4 月至 2016 年 3 月期间接受脑瘤切除术的小儿患者（年龄≤15 岁）的数据，并进行了回顾性分析。根据医院手术量总结了人口统计学特征、治疗程序和住院死亡率。采用惩罚逻辑回归分析调查了医院手术量与住院死亡率之间的关联。
共纳入 1354 名小儿患者。约 40%的患者年龄在 11-15 岁之间。男女比例为 53:47，总粗住院死亡率为 1.8%（n=24），术后 30 天死亡率为 0.4%（n=6）。按体积分为四组，最低四分位数组的粗死亡率为 3.3%，最高四分位数组为 0.8%。在校正协变量后，较高的医院手术量与较低的住院死亡率相关（与每 4 年 1-4 次手术相比，15-25 次手术，比值比[OR]：0.25；95%置信区间[CI]：0.05-0.90，p=0.033；≥26 次手术，OR：0.31；95%CI：0.08-0.96，p=0.042）。
本研究表明小儿脑瘤切除术存在量效关系。为了获得更好的结果，应考虑进一步集中手术。
