Long-term survival after treatment in certified lung cancer centers and not certified hospitals: Results of a large German cohort study using clinical routine data

Abstract

Objective

Lung cancer represents the second most frequent tumor entity worldwide with an increasing number of patients treated in specialized centers. The aim of the WiZen study was to find out whether treatment at hospitals certified by the German Cancer Society (GCS) was associated with long-term survival benefits.

Methods

Data for this cohort study was derived from the largest German statutory health insurance (SHI) AOK, four regional population-based clinical cancer registries (CCR), and standardized hospital quality reports. The analyses were based on 173,999 incident lung cancer patients in the SHI dataset and 35,702 patients in the CCR dataset who received primary treatment for lung cancer (ICD-10-GM C33, C34, D38.1) between 2009 and 2017.

Results

Distributions of age, sex, comorbidities, and most tumor characteristics were similar among patients treated in certified and non-certified hospitals. The Kaplan-Meier estimator for 5-year overall survival was 28.0% for patients from certified and 16.9% from non-certified hospitals (SHI data; CCR data: 21.4% vs. 13.6%). Cox-regression adjusting for relevant confounders yielded hazard ratios of 0.97 (SHI data; 95%CI 0.94, 1.00) and 0.85 (CCR data; 95%CI 0.82, 0.88) for all-cause mortality. The adjusted hazard ratio for recurrence-free survival (CCR data, UICC stage I-III, R0 only) was 0.82 (95%CI 0.75, 0.90).

Conclusions

The presented analyses show that treatment in certified lung cancer centers is associated with relevant survival benefits and should therefore be supported.

Zusammenfassung

Ziel

Lungenkrebs stellt weltweit die zweithäufigste Tumorerkrankung dar und eine zunehmende Anzahl von Patienten wird in spezialisierten Zentren behandelt. Die WiZen-Studie untersucht, ob die Behandlung in von der Deutschen Krebsgesellschaft (DKG) zertifizierten Krankenhäusern mit langfristigen Überlebensvorteilen verbunden ist.

Methoden

Die Daten für diese Kohortenstudie stammen von der größten deutschen gesetzlichen Krankenversicherung (GKV) AOK, vier regionalen, bevölkerungsbezogenen klinischen Krebsregistern (KKR) und standardisierten Qualitätsberichten der Krankenhäuser. Die Analysen basieren auf 173.999 Patienten mit neu diagnostiziertem Lungenkrebs im GKV-Datensatz und 35.702 Patienten im KKR-Datensatz, die zwischen 2009 und 2017 eine Primärbehandlung ihres Lungenkrebses (ICD-10-GM C33, C34, D38.1) erhielten.

Ergebnisse

Ähnliche Verteilungen von Alter, Geschlecht, Begleiterkrankungen und den meisten Tumoreigenschaften wurden bei Patienten in zertifizierten und nicht-zertifizierten Krankenhäusern beobachtet. Der Kaplan-Meier-Schätzer für das 5-Jahres-Gesamtüberleben lag bei 28,0% für Patienten in zertifizierten und bei 16,9% in nicht-zertifizierten Krankenhäusern (GKV-Daten; KKR-Daten: 21,4% vs. 13,6%). Die Cox-Regression, adjustiert für relevante Störfaktoren, ergab Hazard Ratios von 0,97 (GKV-Daten; 95% CI 0,94, 1,00) und 0,85 (KKR-Daten; 95% CI 0,82, 0,88) für die Gesamtmortalität. Das adjustierte Hazard Ratio für das rezidivfreie Überleben (KKR-Daten, UICC-Stadium I-III, nur R0) lag bei 0,82 (95% CI 0,75, 0,90).

Schlussfolgerung

Die vorgestellten Analysen zeigen, dass eine Behandlung in zertifizierten Lungenkrebszentren mit relevanten Überlebensvorteilen verbunden ist und daher gefördert werden sollte.

Keywords

Certified cancer center - specialized treatment - lung cancer - cohort study - survival - quality of cancer care

Schlüsselwörter

Zertifiziertes Krebszentrum - spezialisierte Behandlung - Lungenkrebs - Kohortenstudie - Überleben - Qualität der Krebsversorgung

Publication History

Received: 12 December 2024

Accepted: 16 April 2025

Article published online:
08 July 2025

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