背景:高容量设施(HVF)的治疗与接受治愈性治疗的HNC患者的预后改善有关。这一系统性因素是否会影响接受姑息治疗的HNC患者的生存结局尚不清楚。
目的:研究姑息性治疗机构容量对头颈部肿瘤患者总生存期(OS)的影响。
方法:对2004年至2018年国家癌症数据库中接受姑息治疗的HNC患者进行回顾性查询。
方法:根据治疗机构体积百分位数对患者进行分层。实施多变量二元logistic和Cox比例风险回归模型。
结果:纳入8682例患者,1661(19.1%)在容量≥80百分位数的设施接受了姑息性治疗。在972个设施中,643(66.2%),182(18.7%),85(8.8%),44(4.5%),和18(1.9%)的交易量<20,20-40岁,40-60岁,60-80岁,≥80百分位数,分别。在容量<20的设施中接受姑息治疗的患者的5年OS率,20-40岁,40-60岁,60-80岁,≥80百分位数为11%,13%,11%,14%,23%,分别(P<.001)。设施数量≥80百分位数与多变量Cox回归的较高5年OS相关(aHR0.34,95%CI0.16-0.69,P<.001)。手术治疗(aOR1.34,95%CI1.07-1.68,P=.012)与在容量≥80百分位数的设施中接受治疗相关。
结论:在HVF接受姑息治疗与HNC中的较高OS相关。在临终管理中,应结合其他患者和设施特征,仔细考虑高设施容量带来的生存益处。特别强调以患者为导向的护理目标。
BACKGROUND: Treatment at high-volume facilities (HVF) has been associated with improved prognosis of HNC patients undergoing curative treatment. Whether this systemic factor influences survival outcomes of patients with HNC undergoing palliative treatment is unknown.
OBJECTIVE: To investigate the impact of palliative treatment facility volume on overall survival (OS) in patients with head and neck cancer (HNC).
METHODS: The 2004 to 2018 National Cancer Database was queried retrospectively for patients with HNC undergoing palliative treatment.
METHODS: Patients were stratified based on treatment facility volume percentile. Multivariable binary logistic and Cox proportional hazards regression models were implemented.
RESULTS: Of 8682 patients included, 1661 (19.1%) underwent palliative therapy at facilities with volume ≥80th percentile. Among 972 facilities included, 643 (66.2%), 182 (18.7%), 85 (8.8%), 44 (4.5%), and 18 (1.9%) had volume <20th, 20-40th, 40-60th, 60-80th, and ≥80th percentiles, respectively. 5-year OS rates of patients undergoing palliative therapy at facilities with volume <20th, 20-40th, 40-60th, 60-80th, and ≥80th percentile was 11%, 13%, 11%, 14%, and 23%, respectively (P < .001). Facility volume ≥80th percentile was associated with higher 5-year OS on multivariable Cox regression (aHR 0.34, 95% CI 0.16-0.69, P < .001). Surgical treatment (aOR 1.34, 95% CI 1.07-1.68, P = .012) was associated with undergoing treatment at facilities with volume ≥80th percentile.
CONCLUSIONS: Undergoing palliative treatment at HVFs is associated with higher OS in HNC. The survival benefit derived from high facility volume should be carefully considered in the context of other patient and facility characteristics in end-of-life management, with specific emphasis on patient-directed goals of care.