Introduction
Materials and methods
Study design and population
Data collection
The national transparency initiative
Statistical analyses
Results
Study population
Characteristics | 2007 (N = 348) | 2011 (N = 423) | ||
---|---|---|---|---|
% | 95 % CI | % | 95 % CI | |
Gender | ||||
Male | 56 | 51–61 | 57 | 52–62 |
Female | 44 | 39–49 | 43 | 38–48 |
Missing |
N=13 | |||
Mean age (years) | 66 ± 14 | 66 ± 13 | ||
Charlson indexa
| ||||
High risk | 47 | 42–52 | 46 | 41–51 |
Low risk | 53 | 48–58 | 54 | 49–59 |
Missing |
N = 1 | |||
NHL type | ||||
DLBCL | 42 | 37–47 | 46 | 41–51 |
Follicular lymphoma | 23 | 19–27 | 18 | 14–22 |
Mantle-cell lymphoma | 9 | 6–12 | 5 | 3–7 |
Marginal zone B-cell lymphoma | 8 | 5–11 | 11 | 8–14 |
Other classification | 18 | 14–22 | 20 | 16–24 |
Tumor type | ||||
Aggressive | 61 | 56–66 | 60 | 55–65 |
Indolent | 39 | 34–44 | 40 | 35–45 |
Ann Arbor stage* | ||||
I or II | 44 | 38–50 | 32 | 27–37 |
III or IV | 56 | 50–62 | 68 | 63–73 |
Unknown |
N = 2 |
N = 14 | ||
Not applicable |
N = 39 |
N = 14 | ||
Extranodal disease | ||||
Yes | 58 | 52–64 | 61 | 56–66 |
No | 42 | 36–48 | 39 | 34–44 |
Missing |
N = 42 |
N = 1 | ||
Previous malignancies* | ||||
No (NHL is first malignancy) | 91 | 88–94 | 83 | 79–87 |
Yes | 9 | 6–12 | 17 | 13–21 |
Missing |
N = 1 | |||
Normal LD value*
| ||||
Yes | 20 | 16–24 | 56 | 51–61 |
No | 80 | 76–84 | 44 | 39–49 |
Missing |
N = 32 | |||
Patient’s preferences | ||||
Objections | 6 | 4–8 | 6 | 4–8 |
No objections | 94 | 92–96 | 94 | 92–96 |
Missing |
N = 1 |
N = 1 | ||
Hospital region | ||||
North | 53 | 48–58 | 45 | 40–50 |
East | 25 | 20–30 | 27 | 23–31 |
South | 22 | 18–26 | 28 | 24–32 |
Quality indicator scores
Quality indicator | % 2007 | Number of samples | Missing | Excluded | % 2011 | Number of samples | Missing | Excluded | OR year (95 % CI)a
|
---|---|---|---|---|---|---|---|---|---|
Diagnosis and staging | |||||||||
QI 1 Diagnosis based on histological examination and on an excision or wide incision biopsy | 82 | 212 | 93 | 43 | 79 | 369 | 21 | 33 | 0.840 (0.494–1.428) |
A. Histological examination | 97 | 305 | 0 | 43 | 97 | 389 | 1 | 33 | |
B. Excision or wide incision biopsyb
| 82 | 212 | 93 | 43 | 80 | 369 | 21 | 33 | |
QI 2 Patients staged according to the Ann Arbor classification | 80 | 305 | 0 | 43 | 81 | 390 | 0 | 33 | 1.102 (0.705–1.724) |
QI 3 Diagnosis for NHL based on morphology and immune phenotype | 99 | 283 | 23 | 43 | 96 | 376 | 14 | 33 |
0.190 (0.049–0.744)
|
A. Morphology | 100 | 287 | 18 | 43 | 100 | 378 | 12 | 33 | |
B. Immune phenotype | 99 | 291 | 16 | 43 | 97 | 378 | 12 | 33 | |
C. No molecular clonality (or only supplementary) | 100 | 284 | 21 | 43 | 99 | 376 | 14 | 33 | |
QI 4 Staging techniques should include CT scans of the neck, thorax, and abdomen, bone marrow aspirate, and bone marrow biopsy | 26 | 347 | 1 | 0 | 43 | 421 | 2 | 0 |
1.902 (1.268–2.852)
|
A. CT scan of the neck | 41 | 348 | 0 | 0 | 46 | 421 | 2 | 0 | |
B. CT scan of the thorax | 84 | 348 | 0 | 0 | 75 | 421 | 2 | 0 | |
C. CT scan of the abdomen | 84 | 348 | 0 | 0 | 77 | 421 | 2 | 0 | |
D. Bone marrow aspirate | 68 | 348 | 0 | 0 | 66 | 421 | 2 | 0 | |
E. Bone marrow biopsy (crista) | 85 | 347 | 1 | 0 | 78 | 421 | 2 | 0 | |
QI 5 Assessment of International Prognostic Index (IPI) for patients with aggressive NHL | 21 | 213 | 0 | 135 | 43 | 250 | 4 | 169 |
2.883 (1.675–4.961)
|
QI 6 Assessment of lactate dehydrogenase value | 93 | 347 | 1 | 0 | 92 | 423 | 0 | 0 | 0.995 (0.534–1.855) |
QI 7 Examination of blood counts | 90 | 348 | 0 | 0 | 82 | 422 | 1 | 0 |
0.576 (0.340–0.976)
|
A. Leukocyte count | 99 | 348 | 0 | 0 | 98 | 422 | 1 | 0 | |
B. Leukocyte differentiation | 91 | 348 | 0 | 0 | 83 | 422 | 1 | 0 | |
C. Thrombocyte count | 99 | 348 | 0 | 0 | 97 | 422 | 1 | 0 | |
D. Hemoglobin level | 99 | 348 | 0 | 0 | 98 | 423 | 0 | 0 | |
Treatment and follow-up | |||||||||
QI 8 Reporting of response to therapy using complete remission, partial remission, stable disease, progression, recurrence | 65 | 231 | 25 | 92 | 70 | 318 | 1 | 104 | 1.318 (0.840–2.068) |
QI 9 All target lesions documented in radiology report before therapy | 64 | 227 | 3 | 118 | 67 | 344 | 3 | 76 | 0.917 (0.587–1.432) |
A. Location of lesions reported | 99 | 228 | 2 | 118 | 100 | 344 | 3 | 76 | |
B. Size of lesions reported | 74 | 227 | 3 | 118 | 77 | 344 | 3 | 76 | |
C. Size of lesions reported in mm | 64 | 227 | 3 | 118 | 67 | 344 | 3 | 76 | |
QI 10 All target lesions documented in radiology report after therapy | 67 | 82 | 3 | 263 | 58 | 114 | 3 | 306 | 0.589 (0.275–1.264) |
A. Location of lesions reported | 98 | 84 | 1 | 263 | 98 | 116 | 1 | 306 | |
B. Size of lesions reported | 68 | 82 | 3 | 263 | 70 | 115 | 2 | 306 | |
C. Size of lesions reported in mm | 68 | 83 | 2 | 263 | 58 | 114 | 3 | 306 | |
QI 11 Evaluation after chemotherapy with CT scans (or PET), and for stage IV patients also with a bone marrow aspirate and biopsy | 61 | 176 | 12 | 160 | 62 | 246 | 5 | 172 | 1.583 (0.939–2.668) |
A. CT scan before therapy | 94 | 203 | 0 | 145 | 97 | 269 | 2 | 152 | |
B. CT/PET scan after therapy | 77 | 185 | 13 | 150 | 89 | 250 | 4 | 169 | |
C. Bone marrow aspirate evaluationc
| 46 | 68 | 2 | 278 | 39 | 122 | 0 | 301 | |
D. Bone marrow biopsy evaluationc
| 37 | 68 | 2 | 278 | 45 | 122 | 0 | 301 | |
QI 12 Patients with DLBCL received chemotherapy with RCHOP | 77 | 144 | 1 | 203 | 78 | 194 | 0 | 229 | 1.223 (0.663–2.258) |
QI 13 Dose of RCHOP was not reduced or reason for reduction was reported | 81 | 80 | 31 | 237 | 82 | 111 | 42 | 270 | 0.998 (0.378–2.631) |
Organization and coordination of care | |||||||||
QI 14 Sending and receiving of unfixed biopsy material | 41 | 285 | 20 | 43 | 41 | 321 | 69 | 33 | 0.657 (0.419–1.032) |
QI 15 Integrated reporting of pathology techniques | 88 | 284 | 21 | 43 | 89 | 365 | 25 | 33 | 1.389 (0.752–2.564) |
QI 16 Pathology report should be complete | 12 | 279 | 26 | 43 | 14 | 378 | 12 | 33 | 1.379 (0.792–2.403) |
A. Origin of tissue | 91 | 285 | 20 | 43 | 98 | 378 | 12 | 33 | |
B. Tissue characteristics | 56 | 286 | 19 | 43 | 52 | 378 | 12 | 33 | |
C. Biopsy method | 77 | 305 | 0 | 43 | 91 | 378 | 12 | 33 | |
D. Receipt of material | 41 | 284 | 20 | 43 | 34 | 378 | 12 | 33 | |
E. Frozen tissue | 27 | 284 | 21 | 43 | 21 | 378 | 12 | 33 | |
QI 17 Patients discussed in multidisciplinary consultations | 23 | 346 | 2 | 0 | 41 | 422 | 1 | 0 |
3.360 (2.007–5.624)
|
QI 18 Results of pathology known before the start of treatment (incl. bone marrow) | 73 | 256 | 0 | 92 | 83 | 317 | 2 | 104 | 1.384 (0.866–2.210) |
QI 19 Diagnostic period of 4 weeks after the first visit to the hospital | 56 | 343 | 5 | 0 | 49 | 420 | 3 | 0 | 0.857 (0.599–1.227) |
QI 20 Start of therapy within 2 weeks after diagnostic period | 55 | 234 | 22 | 92 | 54 | 313 | 6 | 104 | 1.263 (0.822–1.941) |