Survival trends in glioblastoma and association with treating facility volume
Survival trends in glioblastoma and association with treating facility volume
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DOI：
10.1016/j.jocn.2019.04.028
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Ailawadhi, Sikander
中科院分区：
文献类型：
--
作者：
Aulakh, Sonikpreet;Dedeo, Michelle R.;Ailawadhi, Sikander
胶质母细胞瘤（GBM）是最致命的癌症之一。多种预后因素影响GBM患者的生存。为了进一步了解这种预后极差的疾病，我们评估了多年来治疗设施容量对总生存期（OS）的影响，特别是在2005年批准使用替莫唑胺（TMZ）的多模式治疗后。利用国家癌症数据库（NCDB）识别2004年至2013年的GBM病例，使用ICD-O-3代码9440/3识别符合条件的患者。在调整了患者、疾病和设施特征后，我们重点研究了治疗设施体积与OS之间的关系。共有60,672名中位年龄为65岁的GBM患者在1166家医院接受治疗。年平均设施容量为3例/年（范围：0.1-55.1），中位OS为8.1个月。2005年之后，所有医院的OS都有所改善，当时TMZ的多模式治疗被批准。在多因素分析中，四分位数中心的治疗（Q4； bb7例患者/年）与全因死亡率的降低独立相关（Q3风险比[HR]: 1.11, 95% CI 1.09, 1.13； Q2风险比[HR]: 1.15, 95% CI 1.12, 1.19； Q1风险比：1.25,95% CI 1.17, 1.33）。治疗设施容量独立影响GBM患者的OS。应解决高容量和低容量中心的可变因素，以减轻结果差异。(C) 2019 Elsevier Ltd.版权所有。
Glioblastoma (GBM) is one of the most lethal cancers. Various prognostic factors impact the survival of GBM patients. To further understand this extremely poor prognosis disease, we evaluated the effect of the treatment facility volumes on overall survival (OS) over the years, especially after the approval of multimodality therapy using temozolomide (TMZ) in 2005. National Cancer Data Base (NCDB) was utilized to identify GBM cases from 2004 through 2013 using ICD-O-3 code 9440/3 to identify eligible patients. We focused on studying the association between treatment facility volume and OS after adjusting for the patient-, disease-, and facility-characteristics. A total of 60,672 eligible GBM patients with median age of 65 years, treated at 1166 facilities were included in this analysis. The median annual facility volume was 3 patients/year (range: 0.1-55.1) and median OS was 8.1 months. There was an improvement in OS across all facilities after 2005, when multimodality therapy with TMZ was approved. Treatment at quartile 4 centers (Q4; >7 patients/year) was independently associated with decreased all-cause mortality in a multivariate analysis (Q3 hazard ratio [HR]: 1.11, 95% CI 1.09, 1.13; Q2 HR: 1.15, 95% CI 1.12, 1.19; Q1 HR: 1.25, 95% CI 1.17, 1.33). Treatment facility volume independently affects OS among GBM patients. Factors that are variable in high- and low-volume centers should be addressed to mitigate outcome disparities. (C) 2019 Elsevier Ltd. All rights reserved.