van Breeschoten Jesper, van den Eertwegh Alfonsus J M, de Wreede Liesbeth C, Hilarius Doranne L, van Zwet Erik W, Haanen John B, Blank Christian U, Aarts Maureen J B, van den Berkmortel Franchette W P J, de Groot Jan Willem B, Hospers Geke A P, Kapiteijn Ellen, Piersma Djura, van Rijn Rozemarijn S, Stevense-den Boer Marion A M, van der Veldt Astrid A M, Vreugdenhil Gerard, Boers-Sonderen Marye J, Suijkerbuijk Karijn P M, Wouters Michel W J M
Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.
Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
Cancers (Basel). 2021 Oct 11;13(20):5077. doi: 10.3390/cancers13205077.
To assure a high quality of care for patients treated in Dutch melanoma centers, hospital variation in treatment patterns and outcomes is evaluated in the Dutch Melanoma Treatment Registry. The aim of this study was to assess center variation in treatments and 2-year survival probabilities of patients diagnosed between 2013 and 2017 in the Netherlands.
We selected patients diagnosed between 2013 and 2017 with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry. Centers' performance on 2-year survival was evaluated using Empirical Bayes estimates calculated in a random effects model. Treatment patterns of the centers with the lowest and highest estimates for 2-year survival were compared.
For patients diagnosed between 2014 and 2015, significant center variation in 2-year survival probabilities was observed even after correcting for case-mix and treatment with new systemic therapies. The different use of new systemic therapies partially explained the observed variation. From 2016 onwards, no significant difference in 2-year survival was observed between centers.
Our data suggest that between 2014 and 2015, after correcting for patient case-mix, significant variation in 2-year survival probabilities between Dutch melanoma centers existed. The use of new systemic therapies could partially explain this variation. In 2013 and between 2016 and 2017, no significant variation between centers existed.
为确保荷兰黑色素瘤治疗中心为患者提供高质量的护理，荷兰黑色素瘤治疗登记处对各医院的治疗模式和治疗结果差异进行了评估。本研究的目的是评估2013年至2017年期间在荷兰确诊的患者在治疗和2年生存概率方面的中心差异。
我们选择了2013年至2017年期间在荷兰黑色素瘤治疗登记处登记的不可切除的IIIC期或IV期黑色素瘤患者。使用随机效应模型中计算的经验贝叶斯估计值评估各中心的2年生存率表现。比较了2年生存率估计值最低和最高的中心的治疗模式。
对于2014年至2015年期间确诊的患者，即使在对病例组合和新的全身治疗进行校正后，仍观察到各中心在2年生存概率方面存在显著差异。新的全身治疗的不同使用部分解释了观察到的差异。从2016年起，各中心之间在2年生存率方面未观察到显著差异。
我们的数据表明，在2014年至2015年期间，在对患者病例组合进行校正后，荷兰黑色素瘤中心之间在2年生存概率方面存在显著差异。新的全身治疗的使用可以部分解释这种差异。在2013年以及2016年至2017年期间,各中心之间不存在显著差异。
