Investigating the correlation between hospital of primary treatment and the survival of women with breast cancer
Investigating the correlation between hospital of primary treatment and the survival of women with breast cancer
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DOI：
10.1002/cncr.21336
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发表时间：
2005-10-01
期刊：
影响因子：
6.2
通讯作者：
Pineault, R
中科院分区：
文献类型：
--
作者：
Hébert-Croteau, N;Brisson, J;Pineault, R
背景为了解初始治疗医院与乳腺癌患者生存率之间的关系，作者调查了治疗中心的特征，这些特征与结果最相关。作者选择了加拿大魁北克5个地区的妇女，她们在1988年至1994年间被诊断为淋巴结阴性乳腺癌。通过图表审查、询问医生以及与管理数据库的链接收集数据。使用Kaplan-Meier方法和考克斯比例风险模型分析1999年底的总生存率。研究人群包括1727名女性，中位随访时间为6.8年。7年生存率为82%（95%可信区间[95%CI]，80-84%）。与在每年100例新发病例的中心接受治疗的妇女相比，任何原因导致死亡的风险比（HR）为1.80（95%CI，1.23-2.63），1.44（95%CI，1.03-2.03）和1.30（95%CI，0.96-1.76）在医院接受治疗的妇女中，新病例< 25例，新病例25-49例，根据病例组合和主治医生的特征进行调整后，每年新增病例50-99例。然而，调整医院类型后，病例量的意义消失了。相比之下，在中心接受现场放疗、研究活动或教学状态治疗的妇女有明显更好的结果，即使在调整病例量后也是如此（HR，0. 68; 95% CI，0. 50 - 0. 92）。这些关联独立于接受的主要治疗，这是一个强有力的决定因素的结果。早期乳腺癌在大医院的初级治疗与生存率的提高有关。这种关系是介导的相关因素的熟练程度的护理，这往往集群内的机构。
BACKGROUND. To understand the relation between hospital of initial treatment andthe survival of women with breast cancer, the authors investigated the characteristics of the treatment center that were related most to outcome.METHODS. The authors selected women from 5 regions of Quebec, Canada, who were diagnosed with lymph node-negative breast cancer between 1988 and 1994. Data were collected by chart review, queries to physicians, and linkage with administrative data bases. Overall survival to the end of 1999 was analyzed using the Kaplan-Meier method and Cox proportional hazards models.RESULTS. The study population included 1727 women with a median follow-up of 6.8 years. The 7-year survival rate was 82% (95% confidence interval [95%CI], 80-84%). Compared with women who were treated in centers with 100 new cases per year, the hazard ratio (HR) of death from any cause was 1.80 (95%CI, 1.23-2.63), 1.44 (95%CI, 1.03-2.03), and 1.30 (95%CI, 0.96-1.76) among women who were treated in hospitals with < 25 new cases, 25-49 new cases, and 50-99 new cases per year after adjusting for case mix and characteristics of the attending physician. However, the significance of caseload disappeared after adjusting for the type of hospital. By contrast, women who were treated in centers with either on-site radiotherapy, research activity, or teaching status had significantly better outcomes, even after adjusting for caseload (HR, 0.68; 95%CI, 0.50-0.92). These associations were independent of primary treatment received, which was a strong determinant of outcome.CONCLUSIONS. Primary treatment of early-stage breast cancer in larger hospitals was associated with improved survival. This relation was mediated by factors related to proficiency of care, which tended to cluster within institutions.