Kaplan Z L R, van Leeuwen N, van Klaveren D, Eijkenaar F, Visser O, Posthuma E F M, Zweegman S, Huls G, van Rhenen A, Blijlevens N M A, Cornelissen J J, van de Loosdrecht A A, Pruijt J H F M, Levin M D, Hoogendoorn M, Lemmens V E P P, Lingsma H F, Dinmohamed A G
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
ESMO Open. 2025 Feb;10(2):104152. doi: 10.1016/j.esmoop.2025.104152. Epub 2025 Jan 30.
Acute myeloid leukemia (AML) requires specialized care, particularly when administrating intensive remission induction chemotherapy (ICT). High-volume hospitals are presumed more adept at delivering this complex treatment, resulting in better overall survival (OS) rates. Despite its potential implications for quality improvement, research on the volume-outcome relationship in ICT administration for AML is scarce. This nationwide, population-based study in the Netherlands explored the volume-outcome relationship in AML.
Data from the Netherlands Cancer Registry on adult (≥18 years of age) ICT-treated AML patients, diagnosed between 2014 and 2018, were analyzed. Hospital volume was assessed against OS using mixed-effects Cox regression, adjusting for patient and disease characteristics (i.e. case mix), with hospital as a random effect.
Our study population consisted of a total of 1761 patients (57% male), with a median age of 61 years. The average annual number of ICT-treated patients varied across the 24 hospitals (range 1-56, median 13, and interquartile range 8-20 patients per hospital per year). Overall, an increase of 10 ICT-treated patients annually was associated with an 8% lower mortality risk [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.87-0.98, P = 0.01]. This association was not significant at 30-day (HR 1.02, 95% CI 0.89-1.17, P = 0.75) and 42-day (HR 0.96, 95% CI 0.85-1.08, P = 0.54) OS but became apparent after 100-day OS (HR 0.91, 95% CI 0.83-0.99, P = 0.05).
There is a volume-outcome association within AML care. This finding could support hospital volume as a metric in AML care. However, it should be acknowledged that centralizing care is a complex process with implications for health care providers and patients. Therefore, any move toward centralization must be judiciously balanced.
急性髓系白血病（AML）需要专门的护理，尤其是在进行强化缓解诱导化疗（ICT）时。大型医院被认为更擅长提供这种复杂的治疗，从而带来更好的总生存率（OS）。尽管这可能对质量改进有潜在影响，但关于AML的ICT治疗中治疗量与治疗结果关系的研究却很少。这项在荷兰进行的基于全国人口的研究探讨了AML治疗中治疗量与治疗结果的关系。
分析了荷兰癌症登记处2014年至2018年间确诊的接受ICT治疗的成年（≥18岁）AML患者的数据。使用混合效应Cox回归评估医院治疗量与总生存率的关系，并对患者和疾病特征（即病例组合）进行调整，将医院作为随机效应。
我们的研究人群共有1761名患者（57%为男性），中位年龄为61岁。24家医院每年接受ICT治疗的患者平均数量各不相同（范围为1 - 56例，中位数为13例，四分位间距为每家医院每年8 - 20例患者）。总体而言，每年接受ICT治疗的患者增加10例，死亡风险降低8%[风险比（HR）0.92，95%置信区间（CI）0.87 - 0.98，P = 0.01]。这种关联在30天（HR 1.02，95% CI 0.89 - 1.17，P = 0.75）和42天（HR 0.96，95% CI 0.85 - 1.08，P = 0.54）总生存率时不显著，但在100天总生存率后变得明显（HR 0.91，95% CI 0.83 - 0.99，P = 0.05）。
AML护理中存在治疗量与治疗结果的关联。这一发现可能支持将医院治疗量作为AML护理的一个指标。然而，应该认识到集中护理是一个复杂的过程，对医疗服务提供者和患者都有影响。因此，任何走向集中化的举措都必须谨慎权衡。
