Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, USA.
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
BMC Cancer. 2021 Feb 9;21(1):146. doi: 10.1186/s12885-021-07868-8.
Medical centers with varying levels of expertise treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs), which are relatively rare tumors. This study assesses the impact of center volume on GEP-NET treatment outcomes.
We used the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims data. The data includes patients diagnosed between 1995 and 2010 who had no health maintenance organization (HMO) coverage, participated in Medicare parts A and B, were older than 65 at diagnosis, had tumor differentiation information, and had no secondary cancer. We identified medical centers at which patients received GEP-NET treatment (surgery, chemotherapy, somatostatin analogues, or radiation therapy) using Medicare claims data. Center volume was divided into 3 tiers - low, medium, and high - based on the number of unique GEP-NET patients treated by a medical center over 2 years. We used Kaplan-Meier curves and Cox regression to assess the association between volume and disease-specific survival.
We identified 899 GEP-NET patients, of whom 37, 45, and 18% received treatment at low, medium volume, and high-volume centers, respectively. Median disease-specific survival for patients at low and medium tiers were 1.4 years and 5.3 years, respectively, but was not reached for patients at high volume centers. Results showed that patients treated at high volume centers had better survival than those treated in low volume centers (HR: 0.63, 95% CI: 0.4-0.9), but showed no difference in outcomes between medium and high-volume centers.
Our results suggest that for these increasingly common tumors, referral to a tertiary care center may be indicated. Physicians caring for GEP-NET patients should consider early referral to high volume centers.
医疗中心的专业水平参差不齐，均对胃胰肠神经内分泌肿瘤（GEP-NETs）进行治疗，而此类肿瘤较为罕见。本研究评估了中心容量对 GEP-NET 治疗结果的影响。
我们使用监测、流行病学和最终结果（SEER）登记处与医疗保险索赔数据相链接。该数据包括 1995 年至 2010 年间诊断的患者，这些患者没有健康维护组织（HMO）覆盖，参与了医疗保险 A 部分和 B 部分，在诊断时年龄超过 65 岁，有肿瘤分化信息，且没有第二原发癌。我们使用医疗保险索赔数据确定了患者接受 GEP-NET 治疗（手术、化疗、生长抑素类似物或放射治疗）的医疗中心。根据医疗中心在两年内治疗的独特 GEP-NET 患者数量，将中心容量分为低、中、高三档。我们使用 Kaplan-Meier 曲线和 Cox 回归评估容量与疾病特异性生存之间的关联。
我们确定了 899 名 GEP-NET 患者，其中 37%、45%和 18%分别在低、中、高容量中心接受治疗。低、中容量中心患者的中位疾病特异性生存时间分别为 1.4 年和 5.3 年，但高容量中心患者的生存时间尚未达到。结果表明，与低容量中心治疗的患者相比，高容量中心治疗的患者生存状况更好（HR：0.63，95%CI：0.4-0.9），但中、高容量中心之间的结果无差异。
我们的结果表明，对于这些日益常见的肿瘤，转诊至三级护理中心可能是必要的。治疗 GEP-NET 患者的医生应考虑将患者尽早转诊至高容量中心。
