FORMULATION AND VALIDATION OF A SURROGATE ESTIMATE FOR THE INTERVAL BETWEEN SURGERY AND ADJUVANT RADIOTHERAPY IN PATIENTS WITH MALIGNANT BRAIN TUMORS BASED ON THE NATIONAL HEALTH INSURANCE DATABASE

以惡性腦瘤病人進行全民健康保險資料庫中手術與輔助放射治療間隔時距估計之方法驗證

李卓穎(Cho-Yin Lee) ； 王育平(Yu-Ping Wang) ； 王裕仁(Yu-Jen Wang) ； 王嘉儁(Chia-Chun Wang)

《放射治療與腫瘤學》 23卷2期 (2016/06) Pp. 99-106

https://doi.org/10.6316/TRO/201623(2)99

摘要

目的：在2011年1月1日前，全民健康保險資料，並未記錄手術或放射治療之執行日期，因而使正確的治療間隔時距之計算受到限制。我們的目的是推導並驗證手術與輔助性放射治療之間隔時距的替代估計方法。材料與方法：本研究自全民健康保險資料庫中提取並回溯分析於2011年1月1日至2012年12月31日期間被診斷為惡性腦瘤並接受手術與輔助性放射治療之個案。手術與輔助性放射治療間隔時距之替代估計值，係依據門診就醫日期及住院首日計算得到。利用最佳配適線性迴歸，以手術與放射治療執行日期計算之正確間隔時距為基準，以驗證該替代估計值。結果：根據 ICD-9診斷碼，1,527例個案被定義為惡性腦瘤診斷。其中394例個案因存在其他癌症診斷而被排除。在剩餘的1,133例個案中，463例接受腦瘤切除手術併術後輔助放射治療的個案被分析。手術與輔助放射治療間隔時距之替代估計值與正確值間的相關性佳，斜率為1.0076，R^2等於0.8633且y截距接近-1。藉由排除間隔時距小於或等於 0之個案，本估計方法可進一步最佳化至R^2等於0.9809而斜率為0.9951且y截距接近5。結論：我們提出了手術與輔助放射治療間隔時距之替代估計方法並驗證之。此研究提供一可能方法，用以克服2011年1月1日前全民健康保險資料日期資訊不充分所造成的限制，使得在進行手術與輔助放射治療間隔時距對癌症預後影響的相關研究時，可以充分利用衛生福利資料庫中大多數的全民健康保險資料進行較大規模的研究。

關鍵字

衛生福利資料庫 ； 全民健康保險 ； 放射治療 ； 間隔時距

並列摘要

Purpose : The date of surgery or radiotherapy (RT) was not recorded in the National Health Insurance database until Jan. 1, 2011, which limits the calculation of the exact time interval between treatments. Our purpose is to formulate and validate a surrogate estimate for the time interval between surgery and adjuvant RT. Materials and Methods: Information of patients with malignant brain tumors diagnosed and treated with surgery and adjuvant RT between Jan. 1, 2011 and Dec. 31, 2012 was obtained from the National Health Insurance (NHI) database and retrospectively analyzed. The surrogate estimate for the interval between surgery and RT was formulated according to the date of outpatient visits and the first date of hospitalization. Surrogate estimate of the interval was validated with the exact interval calculated by the later coded dates of surgery and RT from the database, using the best-fitting linear regression. Results: 1,527 cases of malignant brain tumors were defined according to ICD-9 diagnosis code. 394 cases were excluded for the presence of other cancer diagnoses. Among the remaining 1,133 cases, 463 cases receiving both brain tumor excision and adjuvant RT were analyzed. Surrogate estimate of time intervals and exact time intervals correlate well with a slope of 1.0076, a y-intercept close to -1 day, and an R2 of 0.8633. The calculation is further improved to an R2 of 0.9809 with a slope of 0.9951 and a y-intercept close to 5 days, by excluding cases with surrogate estimates of an interval smaller or equal to 0. Conclusion: Our validated surrogate estimate of the interval between surgery and adjuvant RT provides a possible method to overcome the limitation of inadequate date information before Jan. 1, 2011, and therefore enables the application of most of the data from the Health and Welfare Database for research regarding the effect of RT delay on cancer outcomes.

並列關鍵字

Health and welfare database ； National health insurance ； Radiotherapy ； Time interval