捷克非小细胞肺癌患者诊疗路径与总生存分析
基于捷克2017–2022年管理索赔数据的纵向历史队列研究，纳入5819例非小细胞肺癌患者诊疗路径，以首次支气管镜肺活检及病理检查为索引日期。结果显示仅45.6%患者有多学科团队记录，总人群中位总生存约16个月，治疗集中化与预后呈正相关。
要点
- 仅45.6%患者有多学科团队记录，中位记录时间为20天。
- 总人群中位总生存约16个月，手术患者中位总生存未达到。
- 治疗集中在综合肿瘤中心与患者预后呈正相关。
核心结论
- 该基于管理数据的路径方法可作为癌症诊疗组织与质量评价的技术基础设施。
- 治疗集中在综合肿瘤中心与患者预后呈正相关。
研究设计与样本
- 纵向、历史性描述性队列研究，基于2017–2022年管理索赔数据。
- 索引日期为首次支气管镜肺活检并病理检查，且具有ICD-10诊断码C34。
- 纳入年龄≥18岁且既往无恶性肿瘤的新发患者，共分析5819例患者路径。
主要发现
- 5819例患者中仅45.6%有多学科团队记录，中位记录时间为20天。
- 4417例接受治疗的患者中，30%接受超过一次支气管镜肺活检。
- 接受治疗患者中47.7%接受化疗，25.9%接受手术，16.4%接受放疗，9.08%接受精准治疗。
- 活检后4周内启动治疗的比例：手术患者21%，化疗患者30%，放疗患者23%。
- 总人群中位总生存约16个月，已验证治疗队列为21个月，化疗患者为13个月。
关键数值与推荐
- 活检后4周内启动治疗的比例：手术21%，化疗30%，放疗23%。
- 化疗患者中33%在综合肿瘤中心以外接受治疗。
- 总人群中位总生存约16个月，治疗队列21个月，化疗患者13个月。
临床怎么用
- 可依据管理数据建立肺癌诊疗路径监测和质量评价技术体系。
- 关注多学科团队记录覆盖率偏低，以及化疗患者治疗分散化现象。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Introduction A patient pathway is an evidence-based tool that details the phases of care with the aim of increasing the effectiveness and efficiency of patient care. We describe diagnostic and treatment pathways and related overall survival (OS) of non-small cell lung cancer patients. Methods This was a longitudinal, historical descriptive cohort study based on administrative claim data, spanning from 2017 to 2022. The index date was determined by the first bronchoscopy with lung biopsy (BX) followed by histopathological (HP) examination, alongside the presence of the International Classification of Diseases 10th revision diagnosis code C34. Incident patients aged ≥18 without prior malignancy. Pharmacotherapies (PHT), including chemotherapy (PHT_CT), precision therapy (PHT_IOTT), as well as surgery (SX) and radiotherapy (RT), were investigated associated with OS. A presence of multidisciplinary team (MDT) and treatment at a Complex Oncological Center (COC) with high-load experience was considered. Results We analysed 5819 patient pathways. Less than half (45.6%) of patients had MDT reported within a median of 20 days. Of the 4417 patients treated, 30% underwent more than one BX, 47.7% received PHT_CT, 25.9% underwent SX, 16.4% underwent RT and 9.08% PHT_IOTT. Early initiation of treatment within 4 weeks from BX was identified in 21% of SX patients, 30% of patients treated with PHT_CT and 23% of RT patients. The centralisation of care in COCs primarily concerned SX and PHT_IOTT, while 33% of patients indicated to PHT_CT were treated elsewhere. The median OS reached approximately 16 months in the overall population, 21 months in the verified treated cohort and 13 months in patients treated with PHT_CT, while it was not reached in patients treated with SX. We observed a positive association between patient prognosis and treatment centralisation in COCs. Conclusions This methodology can be implemented as a technical infrastructure to fulfil the organisation and quality evaluation routines in cancer care, largely based on administrative data.
引用
- BMJ Open Respiratory Research：Treatment pathways of lung cancer patients in the Czech Republic: insights from administrative claims data
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。