I期肺癌治疗的可及性指标：可及性改善与生存率提高相关

SCI

6 July 2022

Access to Care Metrics in Stage I Lung Cancer: Improved Access Is Associated with Improved Survival

 (ATS, IF: 4.33)

• Heiden BT, Eaton DB Jr., Chang SH, Yan Y, Schoen MW, Patel MR, KreiselD, Nava RG, Samson P, Meyers BF, Kozower BD, Puri V, Access to Care Metrics in Stage I LungCancer: Improved Access Is Associated with Improved Survival, The Annals of Thoracic Surgery (2022),doi: https://doi.org/10.1016/j.athoracsur.2022.05.047.

BACKGROUND 背景

Equitable access to care is a critical component of comprehensive surgical lung cancer management. Despite this, quality measures (QMs) assessing pre-operative access to care are lacking. We determined several pre-operative QMs based on contemporary treatment guidelines and hypothesized that poor access to care was associated with worse outcomes.

公平获得治疗是肺癌外科全面管理的一个关键组成部分。尽管如此，仍缺乏评估术前治疗可及性的质量指标（QMs）。我们根据当代治疗指南确定了几个术前质量管理指标，并假设获得治疗的困难与较差的结果相关。

METHODS 方法

We performed a retrospective cohort study using a uniquely compiled Veterans Health Administration (VHA) dataset of patients with clinical stage I non-small cell lung cancer (NSCLC) receiving surgical treatment(2006-2016). We defined four QMs that patients with clinical stage I NSCLC should routinely meet in the pre-operative period: timely surgery, positron emission tomography imaging, appropriate smoking management, and pulmonary function testing.We assessed the relationship between meeting these QMs and various short-and long-term outcomes.

我们采用退伍军人健康管理局(VHA)独特汇编的接受手术治疗的临床I期非小细胞肺癌(NSCLC)患者数据集(2006-2016年)进行了一项回顾性队列研究。我们定义了临床I期NSCLC患者在术前应常规满足的四项QMs:及时手术、正电子发射断层成像、适当的吸烟管理和肺功能检查。我们评估了满足这些质量管理与各种短期和长期结果之间的关系。

RESULTS 结果

Among 9,749 Veterans undergoing surgery for clinical stage I NSCLC, 3,371 (34.6%) met all QMs. Factors associated with lower likelihood of meeting all QMs included black race (adjusted odds ratio [aOR] 0.744, 95%CI 0.652-0.848), higher area deprivation index score (e.g., quartile 5 vs. 1, a OR 0.747, 0.647-0.863), and increased distance to hospital (e.g., quartile 5 vs. 1, aOR 0.700, 0.605-0.811). Adherence to all QMs was associated with significantly lower likelihood of post-operative mortality (aOR 0.623, 0.433-0.896) and improved overall survival (adjusted hazard ratio [aHR] 0.897, 0.844-0.954).

在9749名接受临床I期NSCLC手术的退伍军人中，有3371名(34.6%)符合所有质量管理指标。与满足所有质量指标的可能性较低相关的因素包括黑人种族(调整后的优势比 [aHR] 0.744,95%CI 0.652-0.848)，较高的区域剥夺指数(例如，四分位数5比1,OR 0.747, 0.647-0.863)，以及距离医院较远(例如，四分位数5比1,OR 0.700, 0.605-0.811)。遵守所有质量管理指标与显著降低术后死亡率(aOR 0.623, 0.433-0.896)和改善总生存(aHR 0.897, 0.844-0.954)的可能性相关。

CONCLUSIONS 结论

Inadequate access to pre-operative care is associated with worse short-and long-term outcomes in clinical stage I NSCLC. Future VHA policy measures should focus on providing more equitable guideline-concordant care to Veterans.

在临床I期NSCLC中，术前治疗不充分与较差的短期和长期预后相关。未来的VHA政策措施应该集中于为退伍军人提供更公平的与指南一致的照顾。