The association between hospital volume and overall survival in adult AML patients treated with intensive chemotherapy.

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Tác giả: N M A Blijlevens, J J Cornelissen, A G Dinmohamed, F Eijkenaar, M Hoogendoorn, G Huls, Z L R Kaplan, V E P P Lemmens, M D Levin, H F Lingsma, E F M Posthuma, J H F M Pruijt, A A van de Loosdrecht, D van Klaveren, N van Leeuwen, A van Rhenen, O Visser, S Zweegman

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: England : ESMO open , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 552288

BACKGROUND: Acute myeloid leukemia (AML) requires specialized care, particularly when administrating intensive remission induction chemotherapy (ICT). High-volume hospitals are presumed more adept at delivering this complex treatment, resulting in better overall survival (OS) rates. Despite its potential implications for quality improvement, research on the volume-outcome relationship in ICT administration for AML is scarce. This nationwide, population-based study in the Netherlands explored the volume-outcome relationship in AML. MATERIALS AND METHODS: Data from the Netherlands Cancer Registry on adult (≥18 years of age) ICT-treated AML patients, diagnosed between 2014 and 2018, were analyzed. Hospital volume was assessed against OS using mixed-effects Cox regression, adjusting for patient and disease characteristics (i.e. case mix), with hospital as a random effect. RESULTS: Our study population consisted of a total of 1761 patients (57% male), with a median age of 61 years. The average annual number of ICT-treated patients varied across the 24 hospitals (range 1-56, median 13, and interquartile range 8-20 patients per hospital per year). Overall, an increase of 10 ICT-treated patients annually was associated with an 8% lower mortality risk [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.87-0.98, P = 0.01]. This association was not significant at 30-day (HR 1.02, 95% CI 0.89-1.17, P = 0.75) and 42-day (HR 0.96, 95% CI 0.85-1.08, P = 0.54) OS but became apparent after 100-day OS (HR 0.91, 95% CI 0.83-0.99, P = 0.05). CONCLUSIONS: There is a volume-outcome association within AML care. This finding could support hospital volume as a metric in AML care. However, it should be acknowledged that centralizing care is a complex process with implications for health care providers and patients. Therefore, any move toward centralization must be judiciously balanced.
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