Hospital Volume and Survival After Hepatocellular Carcinoma Diagnosis
Hospital Volume and Survival After Hepatocellular Carcinoma Diagnosis
复制标题
DOI：
10.1038/ajg.2016.181
复制
发表时间：
2016-07-01
影响因子：
9.8
通讯作者：
Yopp, Adam C.
中科院分区：
文献类型：
--
作者：
Mokdad, Ali A.;Zhu, Hong;Yopp, Adam C.
目的：医院容量与高风险低容量肿瘤手术后预后之间的关系已得到充分证明。然而，在接受非手术治疗的癌症患者中，这种关联并没有得到很好的理解。我们在一组新诊断的肝细胞癌（HCC）患者中探讨了这种关联。方法：使用2000年至2011年德克萨斯州癌症登记处的数据来研究新诊断为HCC的成年人（来自322家医院的17,231例患者）。采用Contal基于结果的方法将医院容量分为低容量和高容量。采用具有共同虚弱的多变量Cox回归来评估医院容量与总生存率之间的关系。采用混合效应logistic回归探讨治疗方式与医院容量的关系。结果：大多数HCC患者（61%）来自21家大容量医院。确定了24例患者的年度医院容量截断点，以在高容量和低容量医院之间进行分层。大容量医院的患者更常表现为局限性疾病（56比50%，P < 0.01），更有可能接受根治性治疗，包括手术切除、肝移植或消融（22比12%，P < 0.01）。大容量医院与生存率提高显著相关（HR=0.96, 95% CI=0.94-0.98）。在多变量分析中，医院容量与总体治疗利用率的增加相关（OR=1.3, 95% CI=1.2-1.4）。结论：住院容量与总生存率的提高有关，尤其是在局限性HCC中。在肝细胞癌高容量医院中，生存率的提高可能是通过增加治疗的使用来调节的。
OBJECTIVES: The association between hospital volume and outcome following high-risk low volume cancer surgery is well documented. However, this association is not well understood in cancer patients undergoing non-surgical therapies. We explored this association in a cohort of newly diagnosed patients with hepatocellular carcinoma (HCC).METHODS: Data from the 2000 through 2011 in Texas Cancer Registry were used to study adults with newly diagnosed HCC (17,231 patients from 322 hospitals). Hospital volume was stratified into low and high volume using Contal's outcome-based method. A multivariable Cox regression with shared frailty was used to evaluate the association between hospital volume and overall survival. The relationship between treatment modality and hospital volume was explored using mixed effects logistic regression.RESULTS: The majority (61%) of HCC patients were seen in 21 high-volume hospitals. An annual hospital volume cutoff point of 24 patients was determined to stratify between high-and low-volume hospitals. Patients at high-volume hospitals presented more commonly with localized disease (56 vs. 50%, P < 0.01) and were more likely to receive curative therapies including surgical resection, liver transplantation, or ablation (22 vs. 12%, P < 0.01). High-volume hospitals were significantly associated with improved survival (HR=0.96, 95% CI=0.94-0.98). In multivariable analysis, hospital volume was associated with increased overall treatment utilization (OR=1.3, 95% CI=1.2-1.4).CONCLUSIONS: Hospital volume is associated with improved overall survival, particularly in localized HCC. Improved survival may be mediated by increased utilization of treatments in high HCC volume hospitals.