Facility volume and survival in nasopharyngeal carcinoma Journal Article


Authors: Yoshida, E. J.; Luu, M.; David, J. M.; Kim, S.; Mita, A.; Scher, K.; Shiao, S. L.; Tighiouart, M.; Lee, N. Y.; Ho, A. S.; Zumsteg, Z. S.
Article Title: Facility volume and survival in nasopharyngeal carcinoma
Abstract: Introduction: Definitive treatment of nasopharyngeal carcinoma (NPC) is challenging owing to its rarity, complicated regional anatomy, and the intensity of therapy. In contrast to other head and neck cancers, the effect of facility volume has not been well described for NPC. Methods and Materials: The National Cancer Database was queried for patients with stage II-IVB NPC diagnosed from 2004 to 2014 and treated with definitive radiation. Patients with incomplete staging, unknown receipt or timing of treatment, unknown follow-up duration, incomplete socioeconomic information, or treatment outside the reporting facility were excluded. High-volume facilities (HVFs) were defined as the top 5% of facilities according to the annual facility volume. Results: The present analysis included 3941 NPC patients treated at 804 facilities with a median follow-up duration of 59.4 months, including 1025 patients (26.0%) treated at HVFs. Treatment at HVFs was associated with significantly improved overall survival (OS) on multivariable analysis (hazard ratio 0.79, 95% confidence interval 0.69-0.90; P=.001). In propensity score-matched cohorts, 5-year OS was 69.1% versus 63.3% at HVFs versus lower volume facilities (LVFs), respectively (P=.003). Similar results were seen when facility volume was analyzed as a continuous variable. The effect of facility volume on survival varied by academic status (P=.002 for interaction). At academic centers, the propensity score-matched cohorts had 5-year OS of 71.4% compared with 62.4% (P<.001) at HVFs and LVFs, respectively. In contrast, the 5-year OS was 63.5% versus 67.9% (P=.68) in propensity score-matched patients at nonacademic HVFs and LVFs. Conclusions: Treatment at HVFs was associated with improved OS for patients with NPC, with the effect exclusively seen at academic centers. © 2017 Elsevier Inc.
Keywords: adult; cancer survival; middle aged; major clinical study; overall survival; follow up; patient monitoring; data base; confidence interval; nasopharynx carcinoma; multivariate analysis; hazard ratio; patient treatment; nasopharyngeal carcinoma; socioeconomics; diseases; head-and-neck cancer; health care facility; propensity score; continuous variables; multivariable analysis; methods and materials; human; male; female; priority journal; article
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 100
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2018-02-01
Start Page: 408
End Page: 417
Language: English
DOI: 10.1016/j.ijrobp.2017.09.038
PROVIDER: scopus
PUBMED: 29100787
DOI/URL:
Notes: Article -- Export Date: 1 March 2018 -- Source: Scopus
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  1. Nancy Y. Lee
    722 Lee