Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
Cancer Sci. 2022 Mar;113(3):1047-1056. doi: 10.1111/cas.15264. Epub 2022 Jan 13.
In Japan, cancer care hospitals designated by the national government have a surgical volume requirement of 400 annually, which is not necessarily defined based on patient outcomes. This study aimed to estimate surgical volume thresholds that ensure optimal 3-year survival for three periods. In total, 186 965 patients who had undergone surgery for solid cancers in 66 designated cancer care hospitals in Osaka between 2004 and 2012 were examined using data from a population-based cancer registry. These hospitals were categorized by the annual surgical volume of each 50 surgeries (eg, 0-49, 50-99, and so on). Using multivariable Cox proportional hazard regression, we estimated the adjusted 3-year survival probability per surgical volume category for 2004-2006, 2007-2009, and 2010-2012. Using the joinpoint regression model that computes inflection points in a linear relationship, we estimated the points at which the trend of the association between surgical volume and survival probability changes, defining them as surgical volume thresholds. The adjusted 3-year survival ranges were 71.7%-90.0%, 68.2%-90.0%, and 79.2%-90.3% in 2004-2006, 2007-2009, and 2010-2012, respectively. The surgical volume thresholds were identified at 100-149 in 2004-2006 and 2007-2009 and 200-249 in 2010-2012. The extents of change in the adjusted 3-year survival probability per increase of 50 surgical volumes were +4.00%, +6.88%, and +1.79% points until the threshold and +0.41%, +0.30%, and +0.11% points after the threshold in 2004-2006, 2007-2009, and 2010-2012, respectively. The existing surgical volume requirements met our estimated thresholds. Surgical volume thresholds based on the association with patient survival may be used as a reference to validate the surgical volume requirement.
在日本，由国家政府指定的癌症治疗医院每年有 400 例的手术量要求，但这并不一定是基于患者的治疗效果来定义的。本研究旨在为三个时期确定确保最佳 3 年生存率的手术量阈值。在 2004 年至 2012 年间，共有 186965 名在大阪 66 家指定癌症治疗医院接受实体癌手术的患者，他们的资料来自人群癌症登记处。这些医院根据每年每 50 例手术的手术量进行分类（例如，0-49 例、50-99 例等）。使用多变量 Cox 比例风险回归，我们估计了 2004-2006 年、2007-2009 年和 2010-2012 年每例手术量分类的调整后 3 年生存率。使用计算线性关系中拐点的连接点回归模型，我们估计了手术量与生存率之间关联趋势变化的点，将其定义为手术量阈值。调整后的 3 年生存率范围分别为 2004-2006 年为 71.7%-90.0%、2007-2009 年为 68.2%-90.0%和 2010-2012 年为 79.2%-90.3%。2004-2006 年和 2007-2009 年的手术量阈值为 100-149，2010-2012 年的手术量阈值为 200-249。在 2004-2006 年、2007-2009 年和 2010-2012 年，每增加 50 例手术量，调整后的 3 年生存率分别增加 4.00%、6.88%和 1.79%，在阈值后增加 0.41%、0.30%和 0.11%。现有的手术量要求符合我们估计的阈值。基于与患者生存关联的手术量阈值可以作为验证手术量要求的参考。
