高手术量与头颈癌的生存率提高有关。
High surgical volume is associated with improved survival in head and neck cancer.
发表日期：2023 Mar
作者：
Chandler J Rygalski, Zachary M Huttinger, Songzhu Zhao, Guy Brock, Kyle VanKoevering, Matthew O Old, Theodoros N Teknos, James W Rocco, Sidharth V Puram, Nolan B Seim, Brian Swendseid, Catherine T Haring, Antoine Eskander, Stephen Y Kang
来源：
ORAL ONCOLOGY
摘要：
检查头颈部鳞癌（HNSCC）患者手术队列中医院容量和总体死亡率之间的关系。对于2004年至2016年之间诊断为未经治疗的HNSCC成人进行了NCDB的回顾性研究。平均每年医院容量是通过使用在特定医疗机构治疗的头颈癌症病例数量除以该医疗机构向NCDB报告的年数计算的。使用自然三次样条曲线的拐点确定的三组别分类，基于其容量百分位数将设施分为三类:医院组1（<50%）；医院组2（50-90%）；医院组3（90%+）。使用Cox比例风险模型研究了容量百分位数（连续或分类）与患者总体存活率之间的关系，调整了已知会影响存活率的重要患者和设施变量。与其他风险因素调整后，每增加10%的设施百分位数，死亡风险降低2.97%。相对于医院3组设施，医院组1治疗的患者死亡风险增加23.1%（HR 1.231 [95% CI 1.12-1.35]）。医院2组与医院3组之间的死亡风险没有显著差异（HR 1.031 [95% CI 0.97-1.10]）。在年度医院容量> 50个百分位数的医疗机构治疗HNSCC患者的生存率显著提高。这可能支持将护理区域化到具有全面设施和支持服务以最大化患者结果的高容量头颈中心。版权所有©2023 Elsevier出版社。
Examine the relationship between hospital volume and overall mortality in a surgical cohort of head and neck squamous cell carcinoma (HNSCC) patients.A retrospective review of the NCDB was completed for adults with previously untreated HNSCC diagnosed between 2004 and 2016. Mean annual hospital volume was calculated using the number of head and neck cancer cases treated at a given facility divided by the number of years the facility reported to the NCDB. Facilities were separated into three categories based on their volume percentile, informed by inflection points from a natural cubic spline: Hospital Group 1 (<50%); Hospital Group 2 (50-90%); Hospital Group 3 (90%+). Cox proportional hazard models were used to examine the association between volume percentiles (continuous or categorical) with patient overall survival, adjusting for important patient and facility variables known to impact survival.Risk of death decreased by 2.97% for every 10% increase in facility percentile after adjusting for other risk factors. Patients treated at facilities in Hospital Group 1 had a 23.1% increase in risk of mortality (HR 1.231 [95% CI 1.12-1.35]) relative those at facilities in Hospital Group 3. No significant difference in mortality risk was found between Hospital Group 2 versus Hospital Group 3 (HR 1.031 [95% CI 0.97-1.10]).Survival of HNSCC patients is significantly improved when treated at facilities >50th percentile in annual hospital volume. This may support the regionalization of care to high volume head and neck centers with comprehensive facilities and supportive services to maximize patient outcomes.Copyright © 2023 Elsevier Ltd. All rights reserved.