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

IF 7.1 2区医学 Q1 ONCOLOGY

ESMO Open Pub Date : 2025-02-01 DOI:10.1016/j.esmoop.2025.104152

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

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引用次数: 0

Abstract

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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来源期刊

ESMO Open Medicine-Oncology

CiteScore

11.70

自引率

2.70%

发文量

255

审稿时长

10 weeks

期刊介绍： ESMO Open is the online-only, open access journal of the European Society for Medical Oncology (ESMO). It is a peer-reviewed publication dedicated to sharing high-quality medical research and educational materials from various fields of oncology. The journal specifically focuses on showcasing innovative clinical and translational cancer research. ESMO Open aims to publish a wide range of research articles covering all aspects of oncology, including experimental studies, translational research, diagnostic advancements, and therapeutic approaches. The content of the journal includes original research articles, insightful reviews, thought-provoking editorials, and correspondence. Moreover, the journal warmly welcomes the submission of phase I trials and meta-analyses. It also showcases reviews from significant ESMO conferences and meetings, as well as publishes important position statements on behalf of ESMO. Overall, ESMO Open offers a platform for scientists, clinicians, and researchers in the field of oncology to share their valuable insights and contribute to advancing the understanding and treatment of cancer. The journal serves as a source of up-to-date information and fosters collaboration within the oncology community.