Impact of academic medical center access on outcomes in multiple myeloma.
Impact of academic medical center access on outcomes in multiple myeloma.
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学术医疗中心的使用对多发性骨髓瘤预后的影响。
DOI：
10.1002/ajh.26759
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发表时间：
2023
影响因子：
12.8
通讯作者：
Sborov,DouglasW
中科院分区：
文献类型：
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作者：
Vardell,VictoriaA;Ermann,DanielA;Tantravahi,SrinivasK;Haaland,Benjamin;McClune,Brian;Godara,Amandeep;Mohyuddin,GhulamRehman;Sborov,DouglasW
学术癌症中心(ACS)的治疗与提高血液系统恶性肿瘤的存活率有关，尽管在多发性骨髓瘤(MM)中的益处尚未得到检验。这项研究旨在评估接受MM指导治疗的患者在癌症委员会认可的ACS与非学术中心(NAC)的生存结果。国家癌症数据库(NCDB)用于识别2004年至2017年确诊的MM患者的人口统计学和总生存率(OS)，并按设施类型比较结果。在倾向评分匹配的队列中重复生存分析，根据年龄、种族、共病评分、保险、诊断年份、旅行距离和收入，NACS与ACS 1：1匹配。在163ACS375例 多发性骨髓瘤患者中，44.5%是在 治疗。与非急性冠脉综合征相比，急性冠脉综合征患者接受MM导向治疗的可能性更大(81%比73%，p<； .001)。在接受治疗的患者中，急性冠脉综合征的中位OS为71.30个月，而非急性冠脉综合征为41.2个 月(p<； .001)。在调整了基线人口统计学后，在急性冠脉综合征治疗的患者降低了死亡率；风险比(HR)为0.79(95%可信区间为0.78-0.81，p<； .001)。倾向评分匹配的队列保持了这一生存优势，急性冠脉综合征患者的中位OS为59.9个月，而非急性冠脉综合征患者的中位OS为37.0个月(P<； .001)，HR为0.66(95%CI为0.64-0.67，P<； .001)。ACS治疗较年轻的患者，合并疾病较少，更有可能治疗少数族裔、有医疗补助或私人保险的患者，以及未参保的患者。在这项分析中，在急性冠脉综合征治疗的多发性骨髓瘤患者显著提高了存活率。虽然可能与获得专门护理有关，但推动设施选择的社会经济因素也可能起到作用。
Treatment at academic cancer centers (ACs) is associated with improved survival across hematologic malignancies, though the benefit in multiple myeloma (MM) has not been examined. This study aims to evaluate survival outcomes at Commission on Cancer accredited ACs compared to non‐academic centers (NACs) for patients receiving MM‐directed therapy. The National Cancer Database (NCDB) was used to identify demographics and overall survival (OS) of MM patients diagnosed from 2004 to 2017 and to compare outcomes by facility type. Survival analysis was repeated in a propensity score matched cohort, with NACs matched 1:1 to ACs by age, race, comorbidity score, insurance, year of diagnosis, distance traveled, and income. Of 163 375 MM patients, 44.5% were treated at ACs. Patients at ACs were more likely to receive MM‐directed therapy compared to NACs (81% vs. 73%,p< .001). For patients receiving treatment, median OS at ACs was 71.3 months versus 41.2 months at NACs (p< .001). When adjusted for baseline demographics, patients treated at ACs had reduced mortality; hazard ratio (HR) 0.79 (95% CI 0.78–0.81,p< .001). The propensity score matched cohort maintained this survival benefit with a median OS of 59.9 months at ACs versus 37.0 months at NACs (p< .001), HR of 0.66 (95% CI 0.64–0.67,p< .001). ACs treated younger patients with fewer comorbidities and were more likely to treat racial minorities and patients with Medicaid or private insurance, and the uninsured. In this analysis, MM patients treated at ACs have significantly improved survival. While potentially related to access to specialized care, socioeconomic factors that drive facility selection may also contribute.