医院容纳量及护理过程对膀胱癌患者生存的影响

  近日，来自加拿大女王大学的研究人员通过研究调查了高容量医院及外科医生对利用根治性膀胱切除术治疗膀胱癌病人预后结果的影响程度，相关研究发表于国际杂志Urology上。
  文章中，研究人员通过对1994年至2008年间的2802名病人的数据进行研究，发现医院的高容量及外科医生和膀胱癌患者术后并发症减少及较长的生存期之间存在一定关联。Siemens博士表示，这些研究结果非常耐人寻味，而且毫无疑问其会引发一些争论；我们想知道如果给患者带来较好治疗结果的过程和相互作用会通过高容量的医院提供，那么这或许会改善那些低容量医院及外科医生对患者的治疗情况。
  近来许多针对膀胱癌治疗的研究或许都可以帮助理解外科护理的质量如何被运用到进行性的膀胱癌患者机体中，而对于容量-结果关系的解释目前仍未被清晰地解释，研究者表示，未来还需要投入更多的精力去研究医院容量同患者预后结果之间的关联。
  本文研究仅仅阐明了一小部分因子，其或许可以解释高容量提供者（医院和外科医生）为何可以促进患者的预后结果，某些解释或许认为这是更积极地响应政策来在高容量的医院中针对复杂疾病患者带来的集中护理。（转化医学网360zhyx.com）
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Processes of Care and the Impact of Surgical Volumes on Cancer-specific Survival: A Population-based Study in Bladder Cancer
Urology doi:10.1016/j.urology.2014.06.070
D. Robert Siemens, William J. Mackillop, Yingwei Peng, David Berman, Ahmed Elharram, Jonathan Rhee, Christopher M. Booth
Objective
To describe the relationships between procedure volume and late survival after cystectomy for muscle-invasive bladder cancer (MIBC) and explore variables explaining any effect.
Materials and Methods
Electronic records of treatment and surgical pathology reports were linked to a population-based registry to identify patients who underwent cystectomy during 1994-2008 in Ontario, Canada. Explanatory variables included adjuvant chemotherapy, lymph node dissection (LND), and margin status. A Cox proportional hazards regression model was used to explore associations between volume and cancer-specific survival (CSS) as well as overall survival.
Results
The cohort included 2802 MIBC patients treated with cystectomy. High-volume hospitals were more likely to have used adjuvant chemotherapy (25% vs 18%; P <.001), more likely to have performed an LND (83% vs 53%; P <.001), and associated with a lower 90-day mortality (6% vs 10%; P = .032). Low-volume hospitals had a lower 5-year CSS rate of 32% (28%-36%) compared with those of high-volume centers at 38% (33%-42%). Individual surgeon volume was similarly associated with both early- and long-term outcomes. In multivariate analysis, both surgeon and hospital volumes were associated with CSS and overall survival. The surgeon volume effect on long-term outcomes was modestly modified by indicators of the quality of the LND, with little effect of the other explanatory variables.
Conclusion
Higher provider volume is associated with higher CSS in patients with MIBC in the general population. The volume effect was modestly mediated by the quality of LND.