Schoffer Olaf, Wimberger Pauline, Gerken Michael, Bierbaum Veronika, Bobeth Christoph, Rößler Martin, Dröge Patrik, Ruhnke Thomas, Günster Christian, Kleihues-van Tol Kees, Link Theresa, Scharl Anton, Inwald Elisabeth C, Kast Karin, Papathemelis Thomas, Ortmann Olaf, Klinkhammer-Schalke Monika, Schmitt Jochen
Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
Geburtshilfe Frauenheilkd. 2024 Jan 9;84(2):153-163. doi: 10.1055/a-1869-1772. eCollection 2024 Feb.
Certified breast cancer centers offer specific quality standards in terms of their structure, diagnostic and treatment approaches with regards to breast surgery, drug-based cancer therapy, radiotherapy, and psychosocial support. Such centers aim to improve treatment outcomes of breast cancer patients. The question investigated here was whether patients with primary breast cancer have a longer overall survival if they are treated in a certified breast cancer center compared to treatment outside these centers.
We used patient-specific data (demographics, diagnoses, treatments) obtained from data held by mandatory health insurance companies ( , GKV) and clinical cancer registries (KKR) for the period 2009-2017 as well as hospital characteristics recorded in standardized quality reports. Using multivariable Cox regression analysis, we investigated differences in survival between patients treated in hospitals certified as breast cancers centers by the German Cancer Society (DKG) and patients treated in hospitals which had not been certified by the DKG.
The sample population consisted of 143720 (GKV data) and 59780 (KKR data) patients with breast cancer, who were treated in 1010 hospitals across Germany (280 DKG-certified, 730 not DKG-certified). 63.5% (GKV data) and 66.7% (KKR data) of patients, respectively, were treated in DKG-certified breast cancer centers. Cox regression analysis for overall survival which included patient and hospital characteristics found a significantly lower mortality risk for patients treated in DKG-certified breast cancer centers (GKV data: HR = 0.77, 95% CI = 0.74-0.81; KKR data: HR = 0.88, 95% CI = 0.85-0.92). This result remained stable even after several sensitivity analyses including stratified estimates for subgroups of patients and hospitals. The effect was even more pronounced for recurrence-free survival (KKR data: HR = 0.78, 95% CI = 0.74-0.82).
Patients who are treated by an interdisciplinary team in a DKG-certified breast cancer had clear and statistically significantly better survival rates. Certification is therefore an effective means of improving the quality of care, and more patients should be treated in certified breast cancer centers.
认证乳腺癌中心在其结构、乳腺癌手术、基于药物的癌症治疗、放射治疗和心理社会支持等方面的诊断和治疗方法上提供特定的质量标准。这些中心旨在改善乳腺癌患者的治疗结果。这里研究的问题是，与在这些中心之外接受治疗相比，原发性乳腺癌患者在认证乳腺癌中心接受治疗时总体生存期是否更长。
我们使用了从法定健康保险公司（ ，GKV）和临床癌症登记处（KKR）在2009 - 2017年期间保存的数据中获取的患者特定数据（人口统计学、诊断、治疗），以及标准化质量报告中记录的医院特征。使用多变量Cox回归分析，我们研究了在德国癌症协会（DKG）认证为乳腺癌中心的医院接受治疗的患者与未获得DKG认证的医院接受治疗的患者之间的生存差异。
样本人群包括143720名（GKV数据）和59780名（KKR数据）乳腺癌患者，他们在德国的1010家医院接受治疗（280家经DKG认证，730家未获DKG认证）。分别有63.5%（GKV数据）和66.7%（KKR数据）的患者在经DKG认证的乳腺癌中心接受治疗。对包括患者和医院特征在内的总体生存期进行的Cox回归分析发现，在经DKG认证的乳腺癌中心接受治疗的患者死亡风险显著更低（GKV数据：HR = 0.77，95% CI = 0.74 - 0.81；KKR数据：HR = 0.88，95% CI = 0.85 - 0.92）。即使在进行了包括对患者和医院亚组的分层估计在内的多项敏感性分析之后，这一结果仍然稳定。对于无复发生存期，这种效果更为明显（KKR数据：HR = 0.78，95% CI = 0.74 - 0.82）。
在经DKG认证的乳腺癌中心由多学科团队进行治疗的患者具有明显且在统计学上显著更好的生存率。因此，认证是提高医疗质量的有效手段，应该有更多患者在认证乳腺癌中心接受治疗。
