Mariappan Paramananthan, Johnston Allan, Trail Matthew, Hamid Sami, Hollins Graham, Dreyer Barend A, Ramsey Sara, Padovani Luisa, Garau Roberta, Enriquez Julia Guerrero, Boden Alasdair, Maresca Gianluca, Simpson Helen, Hasan Rami, Sharpe Claire, Thomas Benjamin G, Chaudhry Altaf H, Khan Rehan S, Bhatt Jaimin R, Ahmad Imran, Nandwani Ghulam M, Dimitropoulos Konstantinos, Makaroff Lydia, Shaw Johnstone, Graham Catriona, Hendry David
Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; The University of Edinburgh, Edinburgh, UK.
Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK.
Eur Urol Oncol. 2024 Dec;7(6):1327-1337. doi: 10.1016/j.euo.2024.01.012. Epub 2024 Jan 30.
Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland's National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance.
To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC.
DESIGN, SETTING, AND PARTICIPANTS: QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres.
QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC).
The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed.
Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6-9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4-24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73-0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59-0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45-0.84, p = 0.002 and HR 0.65, 95% CI = 0.49-0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control.
Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients.
Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non-muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.
不遵守循证干预措施和指南会导致非肌层浸润性膀胱癌（NMIBC）患者出现显著且多变的复发和进展情况。苏格兰国民保健服务体系（NHS）实施的质量绩效指标（QPI）计划旨在改善癌症治疗效果并减少全国范围内的差异。
评估医院达到两项特定QPI基准对NMIBC患者复发和进展时间的影响。
设计、设置和参与者：膀胱癌（BC）的QPI于2014年4月在全国范围内实施。NHS卫生委员会收集了所有新BC患者的前瞻性数据。前瞻性记录的监测数据来自12个合作中心。
感兴趣的QPI包括（1）在初次经尿道膀胱肿瘤切除术（TURBT）时达到逼尿肌（DM）取样目标的医院，以及（2）TURBT后使用单次丝裂霉素C灌注（SI-MMC）。
主要和次要终点分别为复发时间和进展时间。进行了Kaplan-Meier和Cox多变量回归分析。
在2014年4月1日至2017年3月31日期间，我们诊断出3899例新BC患者，其中2688例为NMIBC。中位随访时间为60.3个月，达到DM取样目标的医院5年复发率比未达到该目标的医院低5.4%（442/1136 [38.9%] 对677/1528 [44.3%]，95%置信区间 [CI] = 1.6 - 9.2，p = 0.005）。SI-MMC与复发率降低20.4%相关（634/1791 [35.4%] 对469/840 [55.8%]，95% CI = 16.4 - 24.5，p < 0.001）。在Cox多变量回归中，达到DM目标和SI-MMC与复发的显著改善相关（风险比 [HR] 0.81，95% CI = 0.73 - 0.91，p = 0.0002；HR 0.66，95% CI = 0.59 - 0.74，p < 0.004），以及无进展生存期（HR 0.62，95% CI = 0.45 - 0.84，p = 0.002；HR 0.65，95% CI = 0.49 - 0.87，p = 0.004）。我们没有全国多中心的QPI前对照。
在全国性QPI计划中，在现实世界中达到DM取样和SI-MMC目标与NMIBC患者复发和进展延迟独立相关。
在苏格兰实施一项新的质量绩效指标计划的前3年，我们评估了非肌层浸润性膀胱癌的依从性和治疗效果。在随访5年的2688例患者中，我们发现分别在经尿道膀胱肿瘤切除术中及术后达到逼尿肌取样目标和单次丝裂霉素C灌注目标与癌症复发和进展延迟相关。
