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Impact of treating facilities' volume on survival for early‐stage laryngeal cancer
Author(s) -
Chen Amy Y.,
Pavluck Alex,
Halpern Michael,
Ward Elizabeth
Publication year - 2009
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.21072
Subject(s) - medicine , hazard ratio , confounding , stage (stratigraphy) , cancer , head and neck cancer , proportional hazards model , laryngeal neoplasm , radiation therapy , oncology , overall survival , survival analysis , volume (thermodynamics) , confidence interval , paleontology , physics , quantum mechanics , biology
Background Treatment at a high‐volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from laryngeal cancer has not been examined previously. Methods A total of 11,446 early‐stage laryngeal cancer patients (1996–1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results Treatment at low‐volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04–1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69–0.80). Conclusion This study is the first to assess the relationship between survival and treatment volume in laryngeal cancer. Treatment at a high‐volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection. © 2009 Wiley Periodicals, Inc. Head Neck, 2009