Association between hospital treatment volume and survival of women with gynecologic malignancy in Japan: a JSOG tumor registry-based data extraction study.
Association between hospital treatment volume and survival of women with gynecologic malignancy in Japan: a JSOG tumor registry-based data extraction study.
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DOI：
10.3802/jgo.2022.33.e3
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发表时间：
2022-01
影响因子：
3.9
通讯作者：
Mikami M
中科院分区：
文献类型：
--
作者：
Machida H;Matsuo K;Oba K;Aoki D;Enomoto T;Okamoto A;Katabuchi H;Nagase S;Mandai M;Yaegashi N;Yamagami W;Mikami M
研究了3种妇科恶性肿瘤患者的医院治疗量与生存结局之间的关系，以及高容量中心的趋势和影响因素。日本妇产科学会肿瘤登记数据库的回顾性研究检查了206，845名妇女，分别有80，741，73，647和52，457名子宫内膜，宫颈和卵巢肿瘤，这些妇女在2004年至2015年期间在日本接受了主要治疗。使用多变量考克斯比例风险模型和限制性三次样条检验每种肿瘤类型的年治疗量和总生存期（OS）之间的相关性。根据危害风险将机构分为3组（低、中、高容量中心）。3种肿瘤的OS风险比（HR）随医院治疗量的增加而降低。对于子宫内膜、宫颈和卵巢肿瘤，分别按病例/年定义高容量（≥50、≥51和≥27）、中等容量（20-49、20-50和17-26）和低容量中心（≤19、≤19和≤16）的治疗量临界点。多变量分析显示，年轻、罕见的肿瘤组织学和初次手术治疗是高容量中心女性的影响因素（所有，p<0.001）。高容量中心治疗的比例下降，而低容量中心治疗的比例增加（所有p<0.001）。高容量中心的治疗改善了OS（子宫内膜、宫颈和卵巢肿瘤的校正HR [aHR]=0.83，95%置信区间[CI]=0.78-0.88; aHR=0.78，95% CI=0.75-0.83; aHR=0.90，95% CI=0.86-0.95）。医院治疗量影响生存结局。高容量中心的治疗为妇科恶性肿瘤妇女提供了生存益处。最近，高容量中心的治疗比例一直在下降。对于妇科恶性肿瘤患者，医院治疗量对生存结局有影响。实践模式随着患者的分散而改变，高容量中心的治疗正在减少。日本的高容量中心与妇科恶性肿瘤的总生存率改善相关。
Associations between hospital treatment volume and survival outcomes for women with 3 types of gynecologic malignancies, and the trends and contributing factors for high-volume centers were examined. The Japan Society of Obstetrics and Gynecology tumor registry databased retrospective study examined 206,845 women with 80,741, 73,647, and 52,457 of endometrial, cervical, and ovarian tumor, respectively, who underwent primary treatment in Japan between 2004 and 2015. Associations between the annual treatment volume and overall survival (OS) for each tumor type were examined using a multivariable Cox proportional hazards model with restricted cubic splines. Institutions were categorized into 3 groups (low-, moderate-, and high-volume centers) based on hazard risks. Hazard ratio (HR) for OS each the 3 tumors decreased with hospital treatment volume. The cut-off points of treatment volume were defined for high- (≥50, ≥51, and ≥27), moderate- (20–49, 20–50, and 17–26), and low-volume centers (≤19, ≤19, and ≤16) by cases/year for endometrial, cervical, and ovarian tumors, respectively. Multivariate analysis revealed younger age, rare tumor histology, and initial surgical management as contributing factors for women at high-volume centers (all, p<0.001). The proportion of high-volume center treatments decreased, whereas low-volume center treatments increased (all p<0.001). Treatment at high-volume centers improved OS than that at other centers (adjusted HR [aHR]=0.83, 95% confidence interval [CI]=0.78–0.88; aHR=0.78, 95% CI=0.75–0.83; and aHR=0.90, 95% CI=0.86–0.95 for endometrial, cervical, and ovarian tumors). Hospital treatment volume impacted survival outcomes. Treatments at high-volume centers conferred survival benefits for women with gynecologic malignancies. The proportion of treatments at high-volume centers have been decreasing recently. For women with gynecologic malignancy, hospital treatment volume had an impact on survival outcome. The practice pattern shifted with scattering of patients and treatments at high-volume centers were decreasing. High-volume centers in Japan were associated with improved overall survival of gynecologic malignancies.