Abstract：
BACKGROUND: To identify the prognostic impact of treatment centralization in patients with testicular germ cell tumors (TGCT).
METHODS: We used a hospital-based cancer registry data in Japan to extract seminoma and non-seminoma cases that were diagnosed in 2013, histologically confirmed, and received the first course of treatment. To compare the 5-years overall survival (OS) rates of patients stratified by institutional care volume, we performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) method to adjust patient backgrounds.
RESULTS: A total of 1767 TGCT patients were identified. The 5-years OS rates for stage II and III TGCT patients treated at low-volume institutions (< 7 cases) were significantly worse than high-volume institutions (≥ 7 cases) (91.2% vs. 83.4%, p = 0.012). Histological stratification revealed that 5-year OS rates for stage II and III seminoma patients in the low-volume group were significantly worse than the high-volume group (93.5% vs. 84.5%, p = 0.041). Multivariate OS analysis using an IPTW-matched cohort showed that institutional care volume was an independent prognostic factor (hazard ratio 2.13 [95% confidence interval: 1.23-3.71], p = 0.0072).
CONCLUSIONS: Our results indicate that stage II and III TGCT patients experience lower survival rates at low-volume institutions and would benefit from treatment centralization.
METHODS: We used a hospital-based cancer registry data in Japan to extract seminoma and non-seminoma cases that were diagnosed in 2013, histologically confirmed, and received the first course of treatment. To compare the 5-years overall survival (OS) rates of patients stratified by institutional care volume, we performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) method to adjust patient backgrounds.
RESULTS: A total of 1767 TGCT patients were identified. The 5-years OS rates for stage II and III TGCT patients treated at low-volume institutions (< 7 cases) were significantly worse than high-volume institutions (≥ 7 cases) (91.2% vs. 83.4%, p = 0.012). Histological stratification revealed that 5-year OS rates for stage II and III seminoma patients in the low-volume group were significantly worse than the high-volume group (93.5% vs. 84.5%, p = 0.041). Multivariate OS analysis using an IPTW-matched cohort showed that institutional care volume was an independent prognostic factor (hazard ratio 2.13 [95% confidence interval: 1.23-3.71], p = 0.0072).
CONCLUSIONS: Our results indicate that stage II and III TGCT patients experience lower survival rates at low-volume institutions and would benefit from treatment centralization.
摘要：
背景：确定睾丸生殖细胞肿瘤（TGCT）患者集中治疗对预后的影响。
方法：我们在日本使用基于医院的癌症登记数据，提取2013年诊断的精原细胞瘤和非精原细胞瘤病例，经组织学证实，并接受了第一个疗程。比较按机构护理量分层的患者的5年总生存率（OS），我们使用治疗加权逆概率(IPTW)方法进行了Cox比例风险回归分析,以调整患者背景.
结果：共发现1767例TGCT患者。在低容量机构（<7例）治疗的II期和III期TGCT患者的5年OS率明显低于高容量机构（≥7例）（91.2％vs.83.4%,p=0.012)。组织学分层显示，低容量组II期和III期精原细胞瘤患者的5年OS率明显低于高容量组（93.5％vs.84.5%,p=0.041)。使用IPTW匹配队列的多变量OS分析显示，机构护理量是独立的预后因素（风险比2.13[95％置信区间：1.23-3.71]，p=0.0072)。
结论：我们的结果表明，II期和III期TGCT患者在低容量机构中的生存率较低，并且将受益于集中治疗。
方法：我们在日本使用基于医院的癌症登记数据，提取2013年诊断的精原细胞瘤和非精原细胞瘤病例，经组织学证实，并接受了第一个疗程。比较按机构护理量分层的患者的5年总生存率（OS），我们使用治疗加权逆概率(IPTW)方法进行了Cox比例风险回归分析,以调整患者背景.
结果：共发现1767例TGCT患者。在低容量机构（<7例）治疗的II期和III期TGCT患者的5年OS率明显低于高容量机构（≥7例）（91.2％vs.83.4%,p=0.012)。组织学分层显示，低容量组II期和III期精原细胞瘤患者的5年OS率明显低于高容量组（93.5％vs.84.5%,p=0.041)。使用IPTW匹配队列的多变量OS分析显示，机构护理量是独立的预后因素（风险比2.13[95％置信区间：1.23-3.71]，p=0.0072)。
结论：我们的结果表明，II期和III期TGCT患者在低容量机构中的生存率较低，并且将受益于集中治疗。
