潮流转变还是集中化力量？台湾头颈癌治疗分布分析（2017-2022年）
Shifting tides or centralizing forces? an analysis of head and neck cancer treatment distribution in Taiwan (2017-2022).
文献信息
| PMID | 42966789 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hsuen-Fu Lin |
| 作者单位 | Department of Hematology and Oncology, Mennonite Christian Hospital, Hualien, 970, Taiwan. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 区域化理论主张将复杂癌症治疗集中于高容量医院，但其在台湾单一支付者全民健康保险体系内的适用性尚不确定。我们描述了2017年至2022年IV期口腔癌（OCC）的医院层面分布，以及p16阳性口咽鳞状细胞癌（OPSCC）和下咽癌的全国初始治疗模式。
方法： 我们对公开可得的、汇总的台湾癌症登记年度报告进行了回顾性分析。对于OCC，我们提取了医学中心和非医学中心的所有病例数和IV期病例数（IV M0加IV M1）。对于p16阳性OPSCC，我们检查了分期特异性初始治疗；主要手术指单纯手术。对于下咽癌，我们描述了全国接受单纯主要手术或同步放化疗（CCRT）的比例。采用Cochran-Armitage检验评估线性趋势。
结果： 医学中心在IV期OCC中的份额从2017年的68.4%（1,437/2,102）小幅下降至2022年的66.6%（1,694/2,542）（趋势P=0.0025）。在I-II期p16阳性OPSCC中，单纯主要手术的使用从12.8%（34/265）下降至7.6%（19/251；趋势P=0.0383），而CCRT是最常见的单一治疗类别。对于下咽癌，单纯主要手术和CCRT的比例大致稳定（分别为7.1%-10.2%和46.4%-51.4%）。
结论： 数据显示IV期OCC的医院层面分布出现小幅变化，而p16阳性OPSCC和下咽癌的全国治疗模式保持稳定。汇总登记数据无法确定治疗适当性、质量、公平性、技术使用或结局。
英文摘要
PURPOSE: Regionalization theory advocates centralizing complex cancer care in high-volume hospitals, but its applicability within Taiwan's single-payer National Health Insurance system is uncertain. We characterized the hospital-level distribution of Stage IV oral cavity cancer (OCC) and national initial-treatment patterns for p16-positive oropharyngeal squamous cell carcinoma (OPSCC) and hypopharyngeal cancer from 2017 to 2022.
METHODS: We conducted a retrospective analysis of publicly available, aggregated Taiwan Cancer Registry Annual Reports. For OCC, we extracted medical-center and non-medical-center counts of all cases and Stage IV cases (IV M0 plus IV M1). For p16-positive OPSCC, we examined stage-specific initial treatment; primary surgery denotes surgery alone. For hypopharyngeal cancer, we described national proportions receiving primary surgery alone or synchronous chemoradiotherapy (CCRT). Cochran-Armitage tests assessed linear trends.
RESULTS: The medical-center share of Stage IV OCC decreased modestly from 68.4% (1,437/2,102) in 2017 to 66.6% (1,694/2,542) in 2022 (P for trend = 0.0025). Among Stage I-II p16-positive OPSCC, primary-surgery-alone use declined from 12.8% (34/265) to 7.6% (19/251; P for trend = 0.0383), while CCRT was the most frequent individual treatment category. For hypopharyngeal cancer, primary-surgery-alone and CCRT proportions were broadly stable (7.1%-10.2% and 46.4%-51.4%, respectively).
CONCLUSIONS: The data show a modest shift in the hospital-level distribution of Stage IV OCC and stable national treatment patterns for p16-positive OPSCC and hypopharyngeal cancer. Aggregated registry data cannot determine treatment appropriateness, quality, equity, technology use, or outcomes.