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The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma
Author(s) -
Goshtasbi Khodayar,
Abiri Arash,
Lehrich Brandon M.,
Haidar Yarah M.,
Tjoa Tjoson,
Kuan Edward C.
Publication year - 2021
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.26739
Subject(s) - medicine , nasopharyngeal carcinoma , proportional hazards model , propensity score matching , hazard ratio , stage (stratigraphy) , comorbidity , multivariate analysis , volume (thermodynamics) , survival analysis , oncology , radiation therapy , confidence interval , paleontology , physics , quantum mechanics , biology
Background This study evaluates the influence of facility case‐volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS). Methods The 2004–2015 National Cancer Database was queried for patients with NPC receiving definitive treatment. Results A total of 8260 patients (5‐year OS: 63.4%) were included. The 1114 unique facilities were categorized into 854 low‐volume (treating 1–8 patients), 200 intermediate‐volume (treating 9–23 patients), and 60 high‐volume (treating 24–187 patients) facilities. Kaplan–Meier log‐rank analysis demonstrated significantly improved OS with high‐volume facilities ( p < 0.001). On cox proportional‐hazard multivariate regression after adjusting for age, sex, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high‐volume facilities were associated with lower mortality risk than low‐volume (HR = 0.865, p = 0.019) and intermediate‐volume facilities (HR = 0.916, p = 0.004). Propensity score matching analysis confirmed this association ( p < 0.001). Conclusion Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high‐volume medical centers.