Author information
1
Radiation Oncology department, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Biostatistics department, The University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Clinical Oncology department, Faculty of medicine, Ain shams University, Cairo, Egypt.
Abstract
BACKGROUND AND AIMS:
The association between case volume and outcomes is well-documented for several cancer types. However, it is unknown if patients with hepatocellular carcinoma treated at high-volume centers have improved overall survival.
METHODS:
135,442 patients diagnosed with hepatocellular carcinoma between 2004-2014 were identified in the Commission on Cancer's National Cancer Database. 53,795 patients were excluded for metastatic or node-positive disease. Average annual case volume was calculated as the total number of cases treated per center from 2004-2014 and dividing by 10. Receiver operating characteristic curves showed the most significant case number threshold between high-volume centers and remaining centers. Univariate and multivariate analyses were performed using Cox regression analysis to determine factors associated with improved survival. Kaplan-Meier curves and log-rank tests were used for overall survival estimates.
RESULTS:
A total of 81,647 patients with stage I-III hepatocellular carcinoma were treated at a total of 1218 centers. The median [range] case volume per year averaged over the 10 year study period was 48.6 [0.1-205.5]. High-volume centers treated >114 cases of hepatocellular carcinoma annually while remaining center treated ≤114 cases. Median survival for patients treated in high-volume centers and remaining centers were 31.9 and 16.6 months, respectively (Log Rank p<0.001). On multivariate analysis, average annual case volume was significantly associated with improved survival.
CONCLUSIONS:
Receiving treatment at a high-volume center is significantly associated with survival for patients with non-metastatic disease. Improved survival at high-volume centers may be related to access to a variety of treatment modalities, multidisciplinary evaluation, and/or subspecialty expertise.