医疗机构容量对鼻咽癌患者治疗和生存结局的影响。
The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma.
机构信息
Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA.
Medical Scientist Training Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
出版信息
Head Neck. 2021 Sep;43(9):2755-2763. doi: 10.1002/hed.26739. Epub 2021 May 17.
BACKGROUND
This study evaluates the influence of facility case-volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS).
METHODS
The 2004-2015 National Cancer Database was queried for patients with NPC receiving definitive treatment.
RESULTS
A total of 8260 patients (5-year OS: 63.4%) were included. The 1114 unique facilities were categorized into 854 low-volume (treating 1-8 patients), 200 intermediate-volume (treating 9-23 patients), and 60 high-volume (treating 24-187 patients) facilities. Kaplan-Meier log-rank analysis demonstrated significantly improved OS with high-volume facilities (p < 0.001). On cox proportional-hazard multivariate regression after adjusting for age, sex, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high-volume facilities were associated with lower mortality risk than low-volume (HR = 0.865, p = 0.019) and intermediate-volume facilities (HR = 0.916, p = 0.004). Propensity score matching analysis confirmed this association (p < 0.001).
CONCLUSION
Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high-volume medical centers.
背景
本研究评估了医疗机构病例量对鼻咽癌（NPC）治疗和总生存率（OS）的影响。
方法
本研究通过查询 2004 年至 2015 年国家癌症数据库，纳入接受根治性治疗的 NPC 患者。
结果
共纳入 8260 例患者（5 年 OS：63.4%）。1114 个独特的医疗机构被分为 854 个低容量（治疗 1-8 例）、200 个中容量（治疗 9-23 例）和 60 个高容量（治疗 24-187 例）医疗机构。Kaplan-Meier 对数秩检验表明，高容量医疗机构的 OS 显著改善（p<0.001）。多因素 Cox 比例风险回归分析显示，与低容量（HR=0.865，p=0.019）和中容量（HR=0.916，p=0.004）医疗机构相比，高容量医疗机构的死亡率风险较低。倾向评分匹配分析也证实了这一关联（p<0.001）。
结论
较高的医疗机构容量是 NPC 患者 OS 改善的独立预测因素，这提示将患者转诊至高容量医疗中心可能带来生存获益。
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