Kotevski Damian P, Vajdic Claire M, Field Matthew, Smee Robert I
Department of Radiation Oncology, Prince of Wales Hospital and Community Health Services, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, New South Wales, Australia.
Kirby Institute, Faculty of Medicine, University of New South Wales, New South Wales, Australia.
Radiother Oncol. 2023 Nov;188:109843. doi: 10.1016/j.radonc.2023.109843. Epub 2023 Aug 4.
Inter-hospital inequalities in head and neck cancer (HNC) survival may exist due to variation in radiotherapy treatment-related factors. This study investigated inter-hospital variation in data collection, primary radiotherapy treatment, and survival in HNC patients from an Australian setting.
Data collected in oncology information systems (OIS) from seven Australian hospitals was extracted for 3,182 adults treated with curative radiotherapy, with or without surgery or chemotherapy, for primary, non-metastatic squamous cell carcinoma of the head and neck (2000-2017). Death data was sourced from the National Death Index using record linkage. Multivariable Cox regression was used to assess the association between survival and hospital.
Inter-hospital variation in data collection, primary radiotherapy dose, and five-year HNC-related death was detected. Completion of eleven fields ranged from 66%-98%. Primary radiotherapy treated Tis-T1N0 glottic and any stage oral cavity and oropharynx cancers received significantly different time-corrected biologically equivalent dose in two gray fractions (EQD2T) by hospital, with observed deviation from Australian radiotherapy guidelines. Increased EQD2T dose was associated with a reduced risk of five-year HNC-related death in all patients and those treated with primary radiotherapy. Hospital, tumour site, and T and N classification were also identified as independent prognostic factors for five-year HNC-related death in all patients treated with radiotherapy.
Unexplained variation exists in HNC-related death in patients treated at Australian hospitals. Available routinely collected data in OIS are insufficient to explain variation in survival. Innovative data collection, extraction, and classification practices are needed to inform clinical practice.
由于放疗治疗相关因素的差异，头颈部癌（HNC）患者的院间生存不平等现象可能存在。本研究调查了澳大利亚环境下头颈部癌患者在数据收集、原发性放疗治疗及生存方面的院间差异。
从澳大利亚七家医院的肿瘤信息系统（OIS）中提取了3182例接受根治性放疗（无论是否联合手术或化疗）的成年患者的数据，这些患者均为原发性、非转移性头颈部鳞状细胞癌（2000 - 2017年）。死亡数据通过记录链接从国家死亡指数获取。采用多变量Cox回归评估生存与医院之间的关联。
检测到数据收集、原发性放疗剂量以及五年HNC相关死亡率方面的院间差异。十一个野的完成率在66% - 98%之间。不同医院对Tis - T1N0声门癌以及任何分期的口腔和口咽癌进行原发性放疗时，接受的两次分割2Gy的时间校正生物等效剂量（EQD2T）存在显著差异，且观察到与澳大利亚放疗指南有偏差。在所有患者以及接受原发性放疗的患者中，EQD2T剂量增加与五年HNC相关死亡风险降低相关。医院、肿瘤部位以及T和N分类也被确定为所有接受放疗患者五年HNC相关死亡的独立预后因素。
在澳大利亚医院接受治疗的患者中，HNC相关死亡存在无法解释的差异。OIS中常规收集的现有数据不足以解释生存差异。需要创新的数据收集、提取和分类方法来为临床实践提供信息。
