Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.
Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.
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DOI：
10.1016/j.ygyno.2017.03.014
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发表时间：
2017-06
影响因子：
4.7
通讯作者：
Garrett JM
中科院分区：
文献类型：
--
作者：
Barber EL;Dusetzina SB;Stitzenberg KB;Rossi EC;Gehrig PA;Boggess JF;Garrett JM
评估高容量医院使用新辅助化疗的变化，并确定医院使用新辅助化疗与生存率之间的关系。我们确定了2006-2012年国家癌症数据库中IIIC或IV期上皮性卵巢癌的偶发病例。入选标准是在高容量医院（>20例/年）接受治疗，并接受化疗和手术治疗。基于病例组合预测因子（年龄、合并症、分期等），使用logistic回归模型预测接受新辅助化疗。根据新辅助化疗的预期使用率将医院分为低利用率、平均利用率或高利用率医院。进行生存分析。我们确定了在55家高容量医院接受治疗的11，574名患者。21.6%（n=2494）的患者使用了新辅助化疗，各医院的使用情况差异很大，从5%-55%不等。高利用率医院（n=1910，10家医院）的新辅助化疗率中位数为39%（范围23-55%），而低利用率医院（n=2671，14家医院）的新辅助化疗率中位数为10%（范围5-17%）。对于所有调整临床和社会人口统计学因素的卵巢癌患者，与低利用率医院治疗相比，在平均或高新辅助化疗利用率医院治疗与死亡率降低相关（HR 0.90 95%CI 0.83-0.97和HR 0.85 95%CI 0.75-0.95）。即使在高容量医院中，利用新辅助化疗治疗IIIC和IV期上皮性卵巢癌的情况也存在很大差异。在新辅助化疗利用率低的医院接受治疗的患者生存率降低。
To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006–2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/yr) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95%CI 0.83–0.97 and HR 0.85 95%CI 0.75–0.95). Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.
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影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
28.4
作者：
Rauh-Hain JA;Melamed A;Wright A;Gockley A;Clemmer JT;Schorge JO;Del Carmen MG;Keating NL
通讯作者：
Keating NL
影响因子：
4.7
作者：
Chi, Dennis S.;Musa, Fernanda;Barakat, Richard R.
通讯作者：
Barakat, Richard R.
影响因子：
4.7
作者：
Aletti, Giovanni D.;Eisenhauer, Eric L.;Cliby, William A.
通讯作者：
Cliby, William A.
影响因子：
4.7
作者：
Bristow, RE;Montz, FJ;Karlan, BY
通讯作者：
Karlan, BY