遵守局部前列腺癌质量标准的国际差异。

IF 8.3 1区 医学 Q1 ONCOLOGY
European urology oncology Pub Date : 2024-12-01 Epub Date: 2024-06-08 DOI:10.1016/j.euo.2024.05.015
Adam B Weiner, Anissa V Nguyen, Amar U Kishan, Robert E Reiter, Mark S Litwin
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引用次数: 0

摘要

背景和目的:遵守指南建议可提高前列腺癌(PCa)患者的治疗质量。我们的目的是评估国际地区对局部区域 PCa 指南的遵循情况:研究队列包括10个国家的Movember TrueNTH全球登记处(n = 62 688;2013-2022年)中确诊为局部区域性PCa的患者。我们评估了四项质量指标的遵守情况:(1) 对低风险 PCa 进行积极监测;(2) 对不利风险 PCa 在诊断后 12 个月内进行明确治疗;(3) 对有利风险 PCa 不进行分期成像;(4) 对不利风险 PCa 进行分期成像。在进行χ2分析时,我们将每个结果按地区输入的最近三年的数据进行了合并,并进行了多重检验调整(P = 0.05 ÷ 4 = 0.0125)。我们还进行了多变量逻辑回归和时间分析:低风险 PCa 的主动监测率从澳大利亚/新西兰的 85%(与美国相比:调整赔率比 [aOR] 1.042,95% 置信区间 [CI] 0.740-1.520] 到中欧的 14%(aOR 0.028,95% CI 0.022-0.036)不等。对于风险较低的患者,在确诊后 12 个月内接受治疗的比例最高的是中欧地区(98%;aOR 2.885,95% CI 1.260-6.603),而意大利为 70%(aOR 0.031,95%CI 0.014-0.072)。未接受影像学检查的良性风险患者比例从美国的 94% 到意大利的 30% 不等(aOR 0.004,95% CI 0.002-0.008),而不良风险 PCa 的影像学检查率从香港的 8% (aOR 65.222,95% CI 43.676-97.398)到美国的 39% 不等(均为 χ2p 结论和临床意义:在这项国际研究中,我们比较了对局部 PCa 优质护理指标的遵守情况,发现了地区差异,这可能是由于文化态度和医疗结构的地区差异造成的。患者总结:我们的研究表明,全球不同地区的前列腺癌患者对推荐管理目标的依从性存在很大差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
International Variations in Adherence to Quality Metrics for Locoregional Prostate Cancer.

Background and objective: Adherence to guideline recommendations can improve the quality of care for patients with prostate cancer (PCa). Our aim was to assess adherence to guidelines for locoregional PCa by international region.

Methods: The study cohort comprised patients diagnosed with locoregional PCa in the 10-country Movember TrueNTH Global Registry (n = 62 688; 2013-2022). We assessed adherence to four quality metrics: (1) active surveillance for low-risk PCa; (2) definitive treatment within 12 mo of diagnosis for unfavorable-risk PCa; (3) no staging imaging for favorable-risk PCa; and (4) staging imaging for unfavorable-risk PCa. For χ2 analyses, we combined the three most recent years of data entered by region for each outcome, with adjustment for multiple tests (p = 0.05 ÷ 4 = 0.0125). We also conducted multivariable logistic regression and temporal analyses.

Key findings and limitations: Active surveillance rates for low-risk PCa ranged from 85% in Australia/New Zealand (vs USA: adjusted odds ratio [aOR] 1.042, 95% confidence interval [CI] 0.740-1.520) to 14% in Central Europe (aOR 0.028, 95% CI 0.022-0.036). For patients with unfavorable-risk disease, the highest uptake rate for treatment within 12 mo of diagnosis was in Central Europe (98%; aOR 2.885, 95% CI 1.260-6.603), compared to 70% in Italy (aOR 0.031, 95%CI 0.014-0.072). The proportion of patients with favorable-risk disease who did not undergo imaging ranged from 94% in the USA to 30% in Italy (aOR 0.004, 95% CI 0.002-0.008), while the rate of imaging for unfavorable-risk PCa ranged from 8% in Hong Kong (aOR 65.222, 95% CI 43.676-97.398) to 39% in the USA (all χ2p < 0.0125). Regional temporal trends also varied.

Conclusions and clinical implications: In this international study comparing adherence to quality care metrics for the quality of care for locoregional PCa, we identified regional variance, possibly because of regional differences in cultural attitudes and health care structures. These benchmarks highlight opportunities for interventions to improve adherence to evidence-based guidelines.

Patient summary: Our study shows that adherence to recommended management goals for patients with prostate cancer varies greatly by global region.

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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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