Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
Ann Surg Oncol. 2020 Oct;27(11):4093-4106. doi: 10.1245/s10434-020-08509-3. Epub 2020 May 6.
The Commission on Cancer recently released quality-of-care measures regarding adequate lymphadenectomy for colon, gastric, lung, and bladder cancer. There is currently little information regarding variation in adequate lymph node yield (ALNY) for gastric, lung, and bladder cancer.
The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for stage I-III gastric, stage I-II lung, and stage II-III bladder cancer resections from 2004 to 2014. Hierarchical models assessed factors associated with ALNY (gastric ≥ 15; lung ≥ 10; bladder ≥ 2). Additionally, the proportions of variation attributable to surgeons, pathologists, and hospitals were estimated among Medicare patients.
Among 3716 gastric, 18,328 lung, and 1512 bladder cancer resections, there were low rates of ALNY (gastric = 53%, lung = 36%, bladder = 67%). When comparing 2004-2006 and 2012-2014, there was significant improvement in ALNY for gastric cancer (39% vs. 68%), but more modest improvement for lung (33% vs. 38%) and bladder (65% vs. 71%) cancer. Large provider-level variation existed for each organ system. After controlling for patient-level factors/variation, the majority of variation was attributable to hospitals (gastric: surgeon = 4%, pathologist = 2.8%, hospital = 40%; lung: surgeon = 13.8%, pathologist = 1.5%, hospital = 18.3%) for gastric and lung cancer. For bladder cancer, most of the variation was attributable to pathologists (surgeon = 3.3%, pathologist = 10.5%, hospital = 6.2%).
ALNY rates are low for gastric, lung, and bladder cancer, with only modest improvement over time for lung and bladder cancer. Given that the proportion of variation attributable to the surgeon, pathologist, and hospital is different for each organ system, future quality improvement initiatives should target the underlying causes, which vary by individual organ system.
癌症委员会最近发布了有关结肠癌、胃癌、肺癌和膀胱癌充分淋巴结切除术的质量控制措施。目前关于胃癌、肺癌和膀胱癌充分淋巴结收获（ALNY）的变化信息很少。
从 2004 年至 2014 年，纽约州癌症登记处和全州规划与研究合作系统查询了 I-III 期胃癌、I-II 期肺癌和 II-III 期膀胱癌切除术。分层模型评估了与 ALNY 相关的因素（胃≥15；肺≥10；膀胱≥2）。此外，还在医疗保险患者中估计了外科医生、病理学家和医院之间的差异比例。
在 3716 例胃癌、18328 例肺癌和 1512 例膀胱癌切除术中，ALNY 率较低（胃癌=53%，肺癌=36%，膀胱癌=67%）。比较 2004-2006 年和 2012-2014 年，胃癌的 ALNY 有显著改善（39%比 68%），但肺癌（33%比 38%）和膀胱癌（65%比 71%）的改善较为温和。每个器官系统都存在较大的提供者水平差异。在控制患者水平因素/变异性后，大多数变异性归因于医院（胃癌：外科医生=4%，病理学家=2.8%，医院=40%；肺癌：外科医生=13.8%，病理学家=1.5%，医院=18.3%），而对于胃癌和肺癌。对于膀胱癌，大部分变异性归因于病理学家（外科医生=3.3%，病理学家=10.5%，医院=6.2%）。
胃癌、肺癌和膀胱癌的 ALNY 率较低，肺癌和膀胱癌的时间仅略有改善。鉴于归因于外科医生、病理学家和医院的变异比例因每个器官系统而异，未来的质量改进举措应针对每个器官系统的潜在原因，这些原因各不相同。
