Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
Belgian Cancer Registry (BCR), Brussels, Belgium.
Eur J Cancer. 2024 Oct;210:114232. doi: 10.1016/j.ejca.2024.114232. Epub 2024 Jul 20.
The study was undertaken to assess the association between certification and volume of breast centres on the one hand and survival on the other in patients with invasive breast cancer (IBC).
The study comprises a cohort of 46,035 patients diagnosed with IBC between 2014 and 2018, selected from the nation-wide Belgian Cancer Registry (BCR) database, which was linked with health insurance, hospital discharge and vital status data. Overall and relative survival probabilities were obtained with Kaplan-Meier method and an actuarial approach based on Ederer II, respectively. The associations between centre certification/volume and relative survival were assessed using Poisson models, adjusted for potential confounders.
Five years after the diagnosis of IBC, the observed and relative survival probabilities for the cohort were 83.4 % (95 %CI: [83.1, 83.8]) and 93.3 % (95 %CI: [92.9, 93.7]), respectively. After adjustment for age and combined tumour stage, the risk to die from BC was 44 % higher (EHR: 1.44, 95 %CI: [1.24, 1.66]) for patients treated in a low-volume centre and 30 % higher (EHR: 1.30, 95 %CI: [1.14, 1.48]) for patients treated in a medium-volume centre, compared to high-volume centres. Likewise, the risk to die from BC was 30 % higher (EHR: 1.30, 95 %CI: [1.15, 1.48], p < 0.001) for patients treated in a non-certified centre (representing 23.8 % of the cohort), compared to patients treated in a coordinating breast clinic.
This population-based study reveals that BC survival is higher when patients are treated in certified and high-volume breast clinics.
本研究旨在评估认证和乳腺中心的规模与浸润性乳腺癌（IBC）患者生存之间的关联。
本研究纳入了 2014 年至 2018 年间从全国比利时癌症登记处（BCR）数据库中选择的 46035 例 IBC 患者队列，该数据库与健康保险、医院出院和生存状态数据相关联。使用 Kaplan-Meier 方法和基于 Ederer II 的 actuarial 方法分别获得总体和相对生存率。使用泊松模型评估中心认证/规模与相对生存率之间的关系，同时调整了潜在混杂因素。
在 IBC 诊断后 5 年，队列的观察生存率和相对生存率分别为 83.4%（95%CI：[83.1, 83.8]）和 93.3%（95%CI：[92.9, 93.7]）。在调整年龄和联合肿瘤分期后，与高容量中心相比，低容量中心（EHR：1.44，95%CI：[1.24, 1.66]）和中容量中心（EHR：1.30，95%CI：[1.14, 1.48]）治疗的患者死于 BC 的风险分别高 44%和 30%。同样，与在协调乳腺诊所治疗的患者相比，在非认证中心（占队列的 23.8%）治疗的患者死于 BC 的风险高 30%（EHR：1.30，95%CI：[1.15, 1.48]，p<0.001）。
这项基于人群的研究表明，当患者在经过认证和高容量的乳腺诊所接受治疗时，BC 的生存率更高。
