乳腺癌多维治疗质量纵向评价的趋势分析

Trend analysis of a longitudinal evaluation for multidimensional treatment quality of breast cancer

目的基于潜变量增长混合模型(Latent growth mixture model,LGMM)分析乳腺癌多维度治疗质量的纵向趋势,识别潜在的变化模式及影响因素,为提高治疗质量和改善患者预后提供科学依据。方法选取国家“特定(单)病种质量监测系统”中连续4年的乳腺癌质量监测数据;基于项目反应理论(Item response theory,IRT)计算乳腺癌在术前检查、治疗以及结局3个维度的治疗质量;构建LGMM分析乳腺癌各维度治疗质量的独立以及联合变化趋势,结合实际意义及统计指标确定最优模型。结果在独立变化趋势分析中,术前检查、治疗和结局维度均识别出2个潜在类别,其中,术前检查维度中呈快速上升趋势占9%、呈相对稳定趋势占91%;治疗维度中稳定增长占23%、缓慢下降占77%;结局维度中呈上升趋势占13%、呈下降趋势占87%。在联合变化趋势分析中,识别出2个潜在类别:第一类占比约8%,该类术前检查维度治疗质量较好,其截距和斜率均值分别为3.326和3.367,治疗和结局维度的治疗质量稳步提高;第二类占比约92%,该类治疗维度治疗质量较好,其截距和斜率均值分别为0.548和0.018,术前检查和结局维度的治疗质量仍有改善空间;患者特征中BMI和M分期是治疗质量联合变化趋势的重要影响因素。结论该研究期间乳腺癌治疗质量在术前检查、治疗和结局各维度均有不同程度的改善;在三个维度的联合变化趋势分析中,术前检查维度治疗质量的提高,可为后续治疗提供可行的参考,达到减少并发症的目的。

Objective The objective of this study was to analyze the longitudinal trend of multidimensional treatment quality of breast cancer based on the latent growth mixture model(LGMM),identify potential change patterns and influencing factors,and provide scientific basis for improving treatment quality and patient prognosis.Methods The quality monitoring data of breast cancer from four consecutive years were obtained in the National“Quality Monitoring System for Specific(single)Disease”;Based on the item response theory(IRT),the treatment quality of breast cancer in the three dimensions of preoperative examination,treatment,and outcome was calculated;LGMM was constructed to analyze the independent and joint change trend of breast cancer treatment quality in all dimensions,and the optimal model was determined based on practical significance and statistical indicators.Results In the independent trend analysis,2 potential categories were identified for preoperative examination,treatment,and outcome dimensions.Among them,9%showed a rapid upward trend in the preoperative examination dimension,and 91%showed a relatively stable trend;The stable growth accounted for 23%and slow decline accounted for 77%in the treatment dimension;13%of the outcome dimensions showed an upward trend,while 87%showed a downward trend.In the joint trend analysis of changes,2 potential categories were identified:the first category accounted for about 8%,and the preoperative examination dimension of this category had a good treatment quality,with mean intercepts and slopes of 3.326 and 3.367,respectively.The treatment quality in the treatment and outcome dimensions had steadily improved;The second category accounted for about 92%,and the treatment quality in this dimension was relatively good.Its mean intercept and slope were 0.548 and 0.018,respectively.There is still room for improvement in the treatment quality of the preoperative examination and outcome dimensions;BMI and M stage in patient characteristics are important influencing factors on the trend of combined changes in treatment quality.Conclusion The treatment quality of breast cancer during this study period has improved to varying degrees in all dimensions of preoperative examination,treatment and outcome;In the joint trend analysis of the three dimensions,the improvement of treatment quality in the preoperative examination dimension can provide feasible references for subsequent treatment and achieve the goal of reducing complications.