Chan Kelley, Palis Bryan E, Cotler Joseph H, Janczewski Lauren M, Zhu Xuan, Boffa Daniel J, Park Ko Un, Boughey Judy C, Plichta Jennifer K, In Haejin, Nogueira Leticia M, Yabroff Robin K, Hawhee Vicki M, Merriman Kelly W, Habermann Elizabeth B, Williams Vonetta L, Mason Karen, Mullett Timothy W, Weigel Ronald J, Nelson Heidi
American College of Surgeons Cancer Programs, Chicago, IL, USA.
Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
Ann Surg Oncol. 2025 Mar;32(3):1553-1564. doi: 10.1245/s10434-024-16801-9. Epub 2024 Dec 31.
This study evaluated the quality of cancer recurrence data in the National Cancer Database (NCDB) to determine if missingness and reporting consistency have improved enough to support national research.
This multi-methods study included NCDB analyses and a cancer registry staff survey. Trends in recurrence data missingness from 2004 to 2021 and multivariable analyses of factors associated with missingness from 2017 to 2021 were evaluated for 4,568,927 patients with non-metastatic cancer. A survey of cancer registry staff at Commission on Cancer-accredited hospitals investigated challenges with recurrence data abstraction.
From 2004 to 2021, recurrence data missingness decreased from 15.7 to 8.4% for breast, 19.8 to 9.3% for colon, 20.5 to 7.4% for lung, 17.6 to 6.6% for melanoma, 29.3 to 9.0% for pancreas, and 18.5 to 9.2% for thyroid cancers. Driving distance ≥100 miles (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.90-2.02) and Southern geographic region (OR 2.86, 95% CI 2.80-2.93) were associated with increased data missingness. Of 565 completed surveys (39.1% response rate), the most common challenges identified were inadequate physician documentation of no evidence of disease (67.8%) and inadequate documentation of recurrence (50.5%). High variability was noted in the interpretation of registry rules specific to the assignment of cancer recurrence or new primary cancer, with discordant assignment occurring 25.5-40.8% of the time.
Despite overall low rates of recurrence data missingness in the NCDB, data quality concerns remain related to inadequate clinical documentation and discrepancies with abstracting practices. Multi-organizational efforts are underway to improve the abstraction of high-quality recurrence data to support outcomes research.
本研究评估了国家癌症数据库（NCDB）中癌症复发数据的质量，以确定缺失情况和报告一致性是否已改善到足以支持全国性研究的程度。
这项多方法研究包括NCDB分析和癌症登记工作人员调查。对4568927例非转移性癌症患者，评估了2004年至2021年复发数据缺失的趋势以及2017年至2021年与缺失相关因素的多变量分析。对癌症委员会认证医院的癌症登记工作人员进行的一项调查，探究了复发数据提取方面的挑战。
从2004年到2021年，乳腺癌复发数据缺失率从15.7%降至8.4%，结肠癌从19.8%降至9.3%，肺癌从20.5%降至7.4%，黑色素瘤从17.6%降至6.6%，胰腺癌从29.3%降至9.0%，甲状腺癌从18.5%降至9.2%。驾驶距离≥100英里（比值比[OR]1.96，95%置信区间[CI]1.90 - 2.02）和南部地理区域（OR 2.86，95% CI 2.80 - 2.93）与数据缺失增加相关。在565份完成的调查问卷（回复率39.1%）中，确定的最常见挑战是医生对无疾病证据的记录不足（67.8%）和复发记录不足（50.5%）。在对特定于癌症复发或新发原发性癌症分配的登记规则的解释中发现了高度变异性，不一致分配发生的时间为25.5% - 40.8%。
尽管NCDB中复发数据缺失率总体较低，但数据质量问题仍然与临床记录不足以及提取实践中的差异有关。正在进行多组织努力以改善高质量复发数据的提取，以支持结局研究。
