Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-07-31 DOI:10.1016/j.clgc.2024.102184

Zhiyu Qian , Dejan K. Filipas , Mara Koelker , Benjamin V. Stone , Edoardo Beatrici , Muhieddine Labban , Kemal Tuncali , Stuart Lipsitz , Quoc-Dien Trinh , Alexander P. Cole

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Abstract

Background

Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments.

Methods

The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient.

Results

Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; P < .001).

Conclusions

Our analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.

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对局部前列腺癌和肾癌采用图像引导聚焦疗法的医院水平差异。

背景：病灶治疗是一种微创手术，可通过图像引导对肾癌和前列腺癌进行靶向治疗。然而，目前在局部前列腺癌和肾癌中采用该疗法的机构情况仍不甚明了。本分析比较了这两种癌症的使用情况，以找出影响采用这些治疗方法的医疗系统决定因素：本研究使用了全国癌症数据库中局部前列腺癌和肾癌成年患者的数据。我们通过具有医院水平随机效应的多变量混合效应逻辑回归模型，计算了每家医院使用焦点疗法的调整概率。我们通过排序毛虫图和斯皮尔曼相关系数分析了医院间的变异性：在 1,559,334 名前列腺癌患者和 425,753 名肾癌患者中，分别有 1.6% 和 6.3% 接受了病灶治疗。前列腺癌的医院间差异从 0.13% 到 32.17%，肾癌的医院间差异从 1.16% 到 30.48%。前列腺癌和肾癌接受病灶治疗的医院间几率呈弱相关性（Spearman's ρ = 0.21; P < .001）：我们的分析表明，医院层面在病灶治疗的使用上存在很大差异。尽管如此，在同一家医院中，这两种癌症的病灶疗法使用率之间的相关性有限。我们的研究结果表明，在医疗机构和医疗系统层面，影响病灶疗法应用的因素是多方面的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.