Determining cause of death in prostate cancer: Are death certificates valid?
Determining cause of death in prostate cancer: Are death certificates valid?
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DOI：
10.1093/jnci/93.23.1822
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发表时间：
2001-12-05
期刊：
影响因子：
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通讯作者：
Stanford, JL
中科院分区：
文献类型：
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作者：
Penson, DF;Albertsen, PC;Stanford, JL
准确评估死因（COD）对于确定癌症研究中的死因特异性生存率非常重要。通过使用预定的临床算法仔细审查住院和门诊病历，可以可靠地确定COD（1）。不幸的是，这种方法虽然对小型回顾性研究有用，但对于癌症研究中常用的大型数据集和国家肿瘤登记处来说是不切实际的。当使用这些大型数据库时，COD被分配有标准化的决策算法，该算法使用国际疾病分类第九修订版（2），代码来分配直接和潜在的COD（3）。然而，这种方法是不可靠的（4，5），特别是当患者年龄较大或有相当多的合并症，如前列腺癌的情况下（6，7）。在一项死亡率趋势的研究中，Grulich et al. (8)据估计，死亡证明和编码的不准确性占1970年至1990年英格兰和威尔士前列腺癌死亡率上升的46%。相比之下，在通过康涅狄格州肿瘤登记处确定的前列腺癌男性中，Albertsen et al. (9)通过审查医疗记录和死亡证明数据，发现基本死因之间存在高度一致性。重要的是，通过死亡证明确定的前列腺癌相关死亡率是可靠的，因为使用大型数据集的研究，如监测，流行病学和最终结果（SEER）1计划，可用于确定干预措施（例如，筛查，根治性前列腺切除术或放疗）是否有效。本研究评估了前列腺癌男性死亡证明上的潜在COD是否与1995年在华盛顿州金县死亡的前列腺癌患者样本中住院病历的独立审查一致。我们的目标是评估编码系统的有效性，目前使用的每个国家确定潜在的COD从死亡证明数据提交给国家卫生统计中心，海茨维尔，MD。所有研究程序均由Fred哈钦森癌症研究中心（西雅图，WA）的机构审查委员会批准。通过使用西雅图-普吉特海峡SEER癌症登记处，我们确定了金郡所有538名男性（死亡时年龄为58-98岁），他们在1973年至1995年期间被诊断患有前列腺癌，并在1995年期间死亡。任何在金郡11家选定医院之一死亡的受试者都有资格参加这项研究。在金郡任何一家医院死亡的171名被诊断为前列腺癌的男性中，有133人（78%）死于研究中选定的11家医院之一。在这133例病例受试者中，可审查128例（96%）的病历。一名经过培训的摘要员使用为既往研究开发的标准化数据表（9）审查病历并评价死亡和合并症前的临床病程。尽管对12例（9%）病例受试者进行了尸检，但这些报告无法供摘要者审查。在提取医疗记录后，三名临床医生（一名医学肿瘤学家和两名泌尿科医生）（所有人都对死亡证明指定的COD不知情）独立审查了提取表，并将基础COD分配到三个前瞻性定义的类别之一：1）与前列腺癌相关，2）与前列腺癌无关，或3）不确定。分配中的分歧通过临床医生之间的共识解决。临床医生对潜在COD的分配然后与死亡证明进行比较，使用国家标准。
Accurate assessment of cause of death (COD) is important for determining cause-specific survival in cancer research. It is possible to reliably ascertain COD by meticulous review of inpatient and outpatient medical records with the use of predetermined clinical algorithms (1). Unfortunately, this method, although useful for small retrospective studies, is impractical for large datasets and national tumor registries that are commonly used for cancer research. When these large databases are used, COD is assigned with a standardized decision algorithm that uses International Classification of Diseases, ninth revision (2), codes to assign both immediate and underlying COD (3). However, this methodology is unreliable (4, 5), particularly when patients are older or have considerable comorbidity, as is the case in prostate cancer (6, 7). In a study of mortality trends, Grulich et al.(8) estimated that inaccuracies in death certification and coding accounted for up to 46% of the noted increase in prostate cancer mortality seen in England and Wales from 1970 through 1990. By contrast, in men with prostate cancer identified through the Connecticut Tumor Registry, Albertsen et al.(9) found a high level of agreement between the underlying COD, determined by a review of the medical records, and death certificate data. It is important that prostate cancer-related mortality ascertained by death certificate be reliable because studies that use large datasets, such as the Surveillance, Epidemiology, and End Results (SEER) 1 Program, may be used to determine whether interventions (eg, screening, radical prostatectomy, or radiotherapy) are effective. This study assessed whether the underlying COD on death certificates for men with prostate cancer agreed with an independent review of inpatient medical records in a sample of prostate cancer patients who died in King County, WA, in 1995. Our goal was to assess the validity of the coding system currently used by each state for determining underlying COD from death certificate data that are submitted to the National Center for Health Statistics, Hyattsville, MD. All study procedures were approved by the Institutional Review Board of the Fred Hutchinson Cancer Research Center, Seattle, WA. With the use of the Seattle–Puget Sound SEER Cancer Registry, we identified all 538 men (aged 58–98 years at time of death) in King County who were diagnosed with prostate cancer from 1973 through 1995 and who died during 1995. Any subject who died at one of 11 selected hospitals in King County was eligible for the study. Of the 171 men diagnosed with prostate cancer who died in any hospital in King County, 133 (78%) died in one of the 11 selected hospitals included in the study. Of these 133 case subjects, medical records could be reviewed for 128 (96%). A trained abstractor used a standardized data form developed for a previous study (9) to review medical records and evaluate clinical course before death and comorbidity. Although autopsies were performed on 12 (9%) case subjects, these reports were not available for review by the abstractor. Following abstraction of the medical records, three clinicians (a medical oncologist and two urologists), all of whom were blinded to the COD assigned by the death certificate, independently reviewed the abstraction forms and assigned an underlying COD to one of three prospectively defined categories: 1) related to prostate cancer, 2) unrelated to prostate cancer, or 3) uncertain. Disagreements in assignments were resolved by consensus among the clinicians. The assignment by the clinicians of underlying COD was then compared with that of the death certificate, using the National …