Adherence to quality measures improves survival in esophageal cancer in a retrospective cohort study of the national cancer database from 2004 to 2016.
Adherence to quality measures improves survival in esophageal cancer in a retrospective cohort study of the national cancer database from 2004 to 2016.
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DOI：
10.21037/jtd-20-1347
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发表时间：
2020-10
影响因子：
2.5
通讯作者：
Odell D
中科院分区：
文献类型：
--
作者：
Adhia A;Feinglass J;Schlick CJ;Odell D
我们评估了III期食管癌患者对四种新型质量指标的依从性，III期食管癌是胃肠道恶性肿瘤的主要死亡原因。我们对2004年至2016年期间从国家癌症数据库（NCDB）中确定的22，871例III期食管癌患者进行了回顾性队列研究。从已发表的指南中定义了四种质量指标：诱导治疗的管理，>15个淋巴结采样，新辅助治疗60天内的手术和R 0切除。采用多元logistic回归分析评估患者人口统计学和治疗变量与措施依从性的相关性。使用考克斯模型比较依从和非依从病例，评估全因死亡风险。Kaplan-Meier生存估计值的组，坚持零至四个四个质量指标。新辅助治疗（93.7%）、手术时机（85.7%）和切除完整性（92.0%）的依从性较高，但淋巴结评价的依从性较低（45.9%）。医疗补助保险状态与新辅助治疗依从性的比值降低[比值比（OR）0.73，95%置信区间（CI）：0.54-0.99]、淋巴结评估（OR 0.81，95% CI：0.68-0.96）和切除完整性（OR 0.71，95% CI：0.54-0.92）相关。从2010年到2016年，与2004年到2005年的病例相比，充分诱导治疗、淋巴结分期和切除完整性的几率逐渐增加，但适时手术的几率逐渐降低。依从性与诱导治疗、淋巴结分期和R 0切除的全因死亡率降低相关，但与手术时机无关。随着个体患者坚持的质量措施数量的增加，生存率得到改善。坚持质量措施与改善III期食管癌患者的生存率相关。了解度量依从性的可变性可以确定质量改进计划的目标。
We assessed adherence to four novel quality measures in patients with stage III esophageal cancer, a leading cause of death among GI malignancies. We performed a retrospective cohort study of 22,871 stage III esophageal cancer patients identified from the National Cancer Database (NCDB) between 2004 and 2016. Four quality measures were defined from published guidelines: administration of induction therapy, >15 lymph nodes sampled, surgery within 60 days of neoadjuvant treatment, and R0 resection. The association of patient demographic and treatment variables with measure adherence was assessed using multiple logistic regression. Risk of all-cause mortality was assessed comparing adherent and non-adherent cases using Cox modeling. Kaplan-Meier survival estimates of groups that adhered to zero to four out of four quality measures were performed. Adherence was high for neoadjuvant treatment (93.7%), timing of surgery (85.7%) and completeness of resection (92.0%), but low for nodal evaluation (45.9%). Medicaid insurance status was associated with decreased odds of adherence for neoadjuvant treatment [odds ratio (OR) 0.73, 95% confidence interval (CI): 0.54–0.99], nodal evaluation (OR 0.81, 95% CI: 0.68–0.96), and completeness of resection (OR 0.71, 95% CI: 0.54–0.92). From 2010 to 2016, when compared to cases from 2004 to 2005, there was a progressive increase in the odds of adequate induction therapy, nodal staging, and completeness of resection, but a progressive decrease in odds of well-timed surgery. Adherence was associated with decreased all-cause mortality for induction therapy, nodal staging, and R0 resection, but not for timing of surgery. Survival improved as the number of quality measures an individual patient adhered to increased. Adherence to quality measures is associated with improved survival in patients with stage III esophageal cancer. Understanding variability in measure adherence may identify targets for quality improvement initiatives.