Russo Ashley, Tseng Joshua, DiPeri Timothy, Pletcher Eric, Lee Jaewon, Chen Courtney, Justo Monica, Razavi Allen, Gong Jun, Atkins Kaitlyn, Burch Miguel, Gangi Alexandra
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Medicine, Cedars-Sinai Medical Oncology, Los Angeles, CA, USA.
Am Surg. 2023 Oct;89(10):4171-4178. doi: 10.1177/00031348231180931. Epub 2023 Jun 6.
The Commission on Cancer (CoC) established quality measures to be reported in National Cancer Database (NCDB) Quality Reporting Tools. Compliance is provided to accredited cancer programs as Cancer Program Practice Profile Reports (CP3R). At the time of this study, the quality metric for gastric cancer (GC) was removal and pathologic examination of 15 regional lymph nodes for resected GC (G15RLN).
This study evaluates national trends in quality metric compliance for GC based on CoC CP3R.
The National Cancer Database (NCDB) was queried from 2004-2017 to identify patients with stage I-III GC who met criteria for inclusion. National trends in compliance were compared. Overall survival (OS) was compared stage for stage.
Overall, 42 997 patients with GC qualified. In 2017, 64.5% of patients met compliance with G15RLN compared to 31.4% in 2004. When comparing academic and non-academic institutions, compliance was met 67.0% vs 60.0% of the time in 2017 ( < .01) and 36% vs 30.6% of the time in 2004 ( < .01). On multivariate logistic regression, patients receiving care at academic institutions (OR 1.5, 95% CI 1.4-1.5) and who underwent surgery at institutions in the >75th percentile for case volume (OR 1.5, 95% CI 1.4-1.6) had higher odds of compliance. When stratified by stage, median OS was better across all stages when compliance was met.
Compliance rates with GC quality measures have improved over time. Compliance with the G15RLN metric is associated with improved OS, stage for stage. Continued efforts to improve compliance rates across all institutions are critical.
癌症委员会（CoC）制定了质量指标，以便在国家癌症数据库（NCDB）质量报告工具中进行报告。合规情况以癌症项目实践概况报告（CP3R）的形式提供给获得认证的癌症项目。在本研究开展时，胃癌（GC）的质量指标是对切除的胃癌进行15个区域淋巴结的切除及病理检查（G15RLN）。
本研究基于CoC CP3R评估胃癌质量指标合规情况的全国趋势。
查询2004年至2017年的国家癌症数据库（NCDB），以确定符合纳入标准的I - III期胃癌患者。比较全国的合规趋势。逐阶段比较总生存期（OS）。
总体而言，42997例胃癌患者符合条件。2017年，64.5%的患者符合G15RLN指标，而2004年为31.4%。比较学术机构和非学术机构时，2017年合规率分别为67.0%和60.0%（P <.01），2004年分别为36%和30.6%（P <.01）。多因素逻辑回归分析显示，在学术机构接受治疗的患者（比值比1.5，95%置信区间1.4 - 1.5）以及在病例量处于第75百分位数以上的机构接受手术的患者（比值比1.5，95%置信区间1.4 - 1.6）合规几率更高。按阶段分层时，各阶段达到合规时的中位总生存期均更好。
随着时间推移，胃癌质量指标的合规率有所提高。符合G15RLN指标与各阶段总生存期改善相关。持续努力提高所有机构的合规率至关重要。
