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Selection of a high-level physician may help improve outcomes of nasopharyngeal carcinoma
Radiotherapy and Oncology ( IF 5.7 ) Pub Date : 2020-06-01 , DOI: 10.1016/j.radonc.2020.03.031
Zhaodong Fei 1 , Xiufang Qiu 1 , Yi Li 1 , Yingying Huang 1 , Mengying Li 1 , Taojun Chen 1 , Li Li 1 , Chaoxiong Huang 1 , Jing Liu 1 , Xiang Lin 1 , Bingyi Wang 1 , Yu Chen 1 , Chuanben Chen 1
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BACKGROUND To assess the relationship between the level of clinical radiation oncologist and the prognosis of patients with nasopharyngeal carcinoma (NPC). To our knowledge, no previous study has explicitly assessed the relationship with cancer prognosis and clinical radiation oncologists level. The effect of physicians on the prognosis has been entirely ignored. METHODS Clinical data were collected for 1140 patients with newly diagnosed NPC. Based on the 3-year overall survival, the treating physicians were classified into 3 grades: high-level group, medium-level group, and low-level group. Cox proportional hazards regression analysis was used to assess the independent significance of different prognostic factors. Propensity score matching (PSM) was used to minimize the influence of confounders so that difference in outcomes provides an unbiased estimate of the influence of physician. Interactive Risk Attributable Program (IRAP) was used to calculate the attribution risk of individual risk factors or a combination of multiple factors. RESULTS The 3-year OS in the high-level, medium-level, and low-level groups was 92.9%, 87.7%, and 83.5%, respectively (p = 0.003). After propensity score matching, the 3-year OS was 92.4%, 87.4%, and 82.9%, respectively (p = 0.004). IRAP was used to calculate the attribution risk of mortality risk. After multivariable adjustment, patient-related factors including tumor accounted for 90.02% [95% confidence interval (CI), 73.43-96.84%) and physician factors accounted for 17.66% (95% CI, 5.39-44.65%) of the mortalityrisk. All related factors, including patient-related factors and physician factors accounted for 92.02% (95% CI, 77.83-97.43%). CONCLUSION Our study demonstrated obvious differences in the prognosis of patients treated by various clinical radiation oncologists. The largest share of prognosis risk was found to be at the patient level, while variation in prognosis was, in part, attributable to differences among physicians.

中文翻译:

选择高级医生可能有助于改善鼻咽癌的预后

背景评价临床放射肿瘤医师水平与鼻咽癌(NPC)患者预后的关系。据我们所知,以前的研究没有明确评估与癌症预后和临床放射肿瘤学家水平的关系。医生对预后的影响完全被忽视了。方法收集1140例初诊鼻咽癌患者的临床资料。根据3年总生存率,将主治医师分为3个等级:高级组、中级组和低级组。Cox比例风险回归分析用于评估不同预后因素的独立显着性。倾向评分匹配 (PSM) 用于最小化混杂因素的影响,以便结果差异提供对医生影响的无偏估计。交互式风险归因程序(IRAP)用于计算单个风险因素或多个因素组合的归因风险。结果 高水平、中水平和低水平组的 3 年 OS 分别为 92.9%、87.7% 和 83.5%(p = 0.003)。倾向评分匹配后,3 年 OS 分别为 92.4%、87.4% 和 82.9%(p = 0.004)。IRAP用于计算死亡风险的归因风险。多变量调整后,包括肿瘤在内的患者相关因素占死亡风险的 90.02% [95% 置信区间 (CI),73.43-96.84%),医师因素占死亡风险的 17.66% (95% CI,5.39-44.65%)。包括患者相关因素和医师因素在内的所有相关因素占92.02%(95% CI,77.83-97.43%)。结论 我们的研究表明,接受不同临床放射肿瘤学家治疗的患者的预后存在明显差异。预后风险的最大份额被发现在患者层面,而预后的差异部分归因于医生之间的差异。
更新日期:2020-06-01
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