Closing the gap: Contribution of surgical best practices to outcome differences between high‐ and low‐volume centers for lung cancer resection
Autor: | Mitchell S. von Itzstein, Yang Xie, Ethan A. Halm, David E. Gerber, Kemp H. Kernstine, Rong Lu, Shidan Wang |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
Male Cancer Research medicine.medical_specialty lobectomy Hospitals Low-Volume Lung Neoplasms lcsh:RC254-282 03 medical and health sciences 0302 clinical medicine Internal medicine Carcinoma Non-Small-Cell Lung medicine Humans Radiology Nuclear Medicine and imaging guidelines Stage (cooking) Practice Patterns Physicians' Lung cancer Pneumonectomy National Cancer Database (NCDB) Original Research Aged Retrospective Studies business.industry volume‐outcome relationship Incidence (epidemiology) Hazard ratio Clinical Cancer Research Retrospective cohort study medicine.disease Prognosis lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens thoracic surgery Survival Rate 030104 developmental biology Oncology Quartile Cardiothoracic surgery 030220 oncology & carcinogenesis Cohort Lymph Node Excision Female business Hospitals High-Volume Follow-Up Studies |
Zdroj: | Cancer Medicine, Vol 9, Iss 12, Pp 4137-4147 (2020) Cancer Medicine |
ISSN: | 2045-7634 |
Popis: | Background Clinical outcomes for resected early‐stage non‐small cell lung cancer (NSCLC) are superior at high‐volume facilities, but reasons for these differences remain unclear. Understanding these differences and optimizing outcomes across institutions are critical to the management of the increasing incidence of these cases. We evaluated the extent to which surgical best practices account for resected early‐stage NSCLC outcome differences between facilities according to case volume. Methods We performed a retrospective cohort study for clinical stage 1 or 2 NSCLC undergoing surgical resection from 2004 to 2013 using the National Cancer Database (NCDB). Surgical best practices (negative surgical margins, lobar or greater resection, lymph node (LN) dissection, and examination of > 10 LNs) were compared between the highest and lowest quartile volumes. Results A total of 150,179 patients were included in the cohort (89% white, 53% female, median age 68 years). In a multivariate model, superior overall survival (OS) was observed at highest volume centers compared to lowest volume centers (hazard ratio (HR) = 0.89; 95% CI, 0.82‐0.96; P = .002). After matching for surgical best practices, there was no significant OS difference (HR = 0.95; 95% CI, 0.87‐1.05; P = .32). Propensity score‐adjusted HR estimates indicated that surgical best practices accounted for 54% of the numerical OS difference between low‐volume and high‐volume centers. Each surgical best practice was independently associated with improved OS (all P ≤ .001). Conclusion Quantifiable and potentially modifiable surgical best practices largely account for resected early‐stage NSCLC outcome differences observed between low‐ and high‐volume centers. Adherence to these guidelines may reduce and potentially eliminate these differences. High‐volume facilities have been observed to be associated with improved outcomes compared to low‐volume facilities for non‐small cell lung cancer surgery. We found that controlling for surgical quality measures minimizes outcome differences between facility types, suggesting that high‐quality care provision for lung cancer surgery requires compliance with surgical quality measures. |
Databáze: | OpenAIRE |
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