Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non-muscle-invasive Bladder Cancer.

IF 8.3 1区 医学 Q1 ONCOLOGY
European urology oncology Pub Date : 2024-12-01 Epub Date: 2024-01-30 DOI:10.1016/j.euo.2024.01.012
Paramananthan Mariappan, Allan Johnston, Matthew Trail, Sami Hamid, Graham Hollins, Barend A Dreyer, Sara Ramsey, Luisa Padovani, Roberta Garau, Julia Guerrero Enriquez, Alasdair Boden, Gianluca Maresca, Helen Simpson, Rami Hasan, Claire Sharpe, Benjamin G Thomas, Altaf H Chaudhry, Rehan S Khan, Jaimin R Bhatt, Imran Ahmad, Ghulam M Nandwani, Konstantinos Dimitropoulos, Lydia Makaroff, Johnstone Shaw, Catriona Graham, David Hendry
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引用次数: 0

Abstract

Background: Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland's National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance.

Objective: To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC.

Design, setting, and participants: QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres.

Intervention: QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC).

Outcome measurements and statistical analysis: The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed.

Key findings and limitations: Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6-9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4-24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73-0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59-0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45-0.84, p = 0.002 and HR 0.65, 95% CI = 0.49-0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control.

Conclusions: Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients.

Patient summary: Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non-muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.

达到国家质量指标基准可降低非肌层浸润性膀胱癌的复发率和病情进展。
背景:不遵守循证干预措施和指南会导致非肌层浸润性膀胱癌(NMIBC)患者的复发和病情进展情况严重且变化不定。苏格兰国家医疗服务体系(NHS)实施了一项质量绩效指标(QPI)计划,旨在改善癌症治疗效果并减少全国范围内的差异:目的:评估医院达到两个特定 QPI 基准对 NMIBC 复发和进展时间的影响:膀胱癌(BC)的 QPI 于 2014 年 4 月在全国范围内实施。英国国家医疗服务体系卫生局收集了所有膀胱癌新患者的前瞻性数据。12个合作中心汇集了前瞻性记录的监测数据:干预措施:关注的 QPI 为:(1)医院在最初的经尿道膀胱肿瘤切除术(TURBT)中实现逼尿肌(DM)取样目标;(2)TURBT 后使用丝裂霉素 C 单次灌注(SI-MMC):主要终点和次要终点分别为复发时间和病情进展时间。主要研究结果和局限性:2014年4月1日至2017年3月31日期间,我们共诊断出3899例新发BC患者,其中2688例为NMIBC 。中位随访时间为60.3个月,与未达到DM抽样目标的医院相比,达到DM抽样目标的医院5年复发率低5.4%(442/1136 [38.9%] vs 677/1528 [44.3%],95%置信区间[CI] = 1.6-9.2, p = 0.005)。SI-MMC的复发率降低了20.4%(634/1791 [35.4%] vs 469/840 [55.8%],95% CI = 16.4-24.5,P 结论:SI-MMC的复发率降低了20.4%:在一项国家 QPI 计划中,在现实世界中达到 DM 和 SI-MMC 抽样目标与推迟 NMIBC 患者的复发和病情进展密切相关:在苏格兰实施一项新颖的质量绩效指标计划 3 年后,我们对非肌层浸润性膀胱癌患者的依从性和治疗效果进行了评估。在对 2688 名患者进行了为期 5 年的随访后,我们发现,在经尿道膀胱肿瘤切除术中和切除术后分别实现对逼尿肌取样和丝裂霉素 C 单次灌注的目标与癌症复发和进展的延迟有关。
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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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