John M David1,2, Allen S Ho2,3, Michael Luu4, Emi J Yoshida1,2, Sungjin Kim2,4, Alain C Mita2, Kevin S Scher2, Stephen L Shiao1,2, Mourad Tighiouart2,4, Zachary S Zumsteg1,2. 1. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California. 2. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California. 3. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California. 4. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
BACKGROUND: The treatment of head and neck cancers is complex and associated with significant morbidity, requiring multidisciplinary care and physician expertise. Thus, facility characteristics, such as clinical volume and academic status, may influence outcomes. METHODS: The current study included 46,567 patients taken from the National Cancer Data Base who were diagnosed with locally advanced invasive squamous cell carcinomas of the oropharynx, larynx, and hypopharynx and were undergoing definitive radiotherapy. High-volume facilities (HVFs) were defined as the top 1% of centers by the number of patients treated from 2004 through 2012. Multivariable Cox regression and propensity score matching were performed to account for imbalances in covariates. RESULTS: The median follow-up was 55.1 months. Treatment at a HVF (hazard ratio, 0.798; 95% confidence interval, 0.753-0.845 [P<.001]) and treatment at an academic facility (hazard ratio, 0.897; 95% confidence interval, 0.871-0.923 [P<.001]) were found to be independently associated with improved overall survival in multivariable analysis. In propensity score-matched cohorts, the 5-year overall survival rate was 61.6% versus 55.5% for patients treated at an HVF versus lower-volume facilities, respectively (P<.001). Similarly, the 5-year overall survival rate was 52.3% versus 49.7% for patients treated at academic versus nonacademic facilities (P<.001). Analysis of facility volume as a continuous variable demonstrated continual improvement in survival with an increased number of patients treated. The impact of facility volume and academic designation on survival was observed when using a variety of thresholds to define HVF, and across the vast majority of subgroups, including both oropharyngeal and nonoropharyngeal subsites. CONCLUSIONS: Patients with locally advanced head and neck squamous cell carcinoma who are undergoing curative radiotherapy at HVFs and academic centers appear to have improved survival. Cancer 2017;123:3933-42.
BACKGROUND: The treatment of head and neck cancers is complex and associated with significant morbidity, requiring multidisciplinary care and physician expertise. Thus, facility characteristics, such as clinical volume and academic status, may influence outcomes. METHODS: The current study included 46,567 patients taken from the National Cancer Data Base who were diagnosed with locally advanced invasive squamous cell carcinomas of the oropharynx, larynx, and hypopharynx and were undergoing definitive radiotherapy. High-volume facilities (HVFs) were defined as the top 1% of centers by the number of patients treated from 2004 through 2012. Multivariable Cox regression and propensity score matching were performed to account for imbalances in covariates. RESULTS: The median follow-up was 55.1 months. Treatment at a HVF (hazard ratio, 0.798; 95% confidence interval, 0.753-0.845 [P<.001]) and treatment at an academic facility (hazard ratio, 0.897; 95% confidence interval, 0.871-0.923 [P<.001]) were found to be independently associated with improved overall survival in multivariable analysis. In propensity score-matched cohorts, the 5-year overall survival rate was 61.6% versus 55.5% for patients treated at an HVF versus lower-volume facilities, respectively (P<.001). Similarly, the 5-year overall survival rate was 52.3% versus 49.7% for patients treated at academic versus nonacademic facilities (P<.001). Analysis of facility volume as a continuous variable demonstrated continual improvement in survival with an increased number of patients treated. The impact of facility volume and academic designation on survival was observed when using a variety of thresholds to define HVF, and across the vast majority of subgroups, including both oropharyngeal and nonoropharyngeal subsites. CONCLUSIONS:Patients with locally advanced head and neck squamous cell carcinoma who are undergoing curative radiotherapy at HVFs and academic centers appear to have improved survival. Cancer 2017;123:3933-42.
Authors: Loren K Mell; Hanjie Shen; Phuc Felix Nguyen-Tân; David I Rosenthal; Kaveh Zakeri; Lucas K Vitzthum; Steven J Frank; Peter B Schiff; Andy M Trotti; James A Bonner; Christopher U Jones; Sue S Yom; Wade L Thorstad; Stuart J Wong; George Shenouda; John A Ridge; Qiang E Zhang; Quynh-Thu Le Journal: Clin Cancer Res Date: 2019-08-16 Impact factor: 12.531
Authors: Nicholas C J Lee; Jacqueline R Kelly; Yi An; Henry S Park; Benjamin L Judson; Barbara A Burtness; Zain A Husain Journal: Cancer Date: 2019-02-12 Impact factor: 6.860
Authors: Kelsey L Corrigan; Leticia Nogueira; K Robin Yabroff; Chun Chieh Lin; Xuesong Han; Junzo P Chino; Anna E Coghill; Meredith Shiels; Ahmedin Jemal; Gita Suneja Journal: Cancer Date: 2019-11-11 Impact factor: 6.860
Authors: Katri Aro; Allen S Ho; Michael Luu; Sungjin Kim; Mourad Tighiouart; Jon Mallen-St Clair; Emi J Yoshida; Stephen L Shiao; Ilmo Leivo; Zachary S Zumsteg Journal: Cancer Date: 2018-05-09 Impact factor: 6.860
Authors: Evan M Graboyes; Mark A Ellis; Hong Li; John M Kaczmar; Anand K Sharma; Eric J Lentsch; Terry A Day; Chanita Hughes Halbert Journal: Cancer Date: 2018-06-22 Impact factor: 6.860
Authors: Benjamin F Bitner; Brandon M Lehrich; Arash Abiri; Tyler M Yasaka; Frank P K Hsu; Edward C Kuan Journal: Pituitary Date: 2021-04-30 Impact factor: 4.107
Authors: Khodayar Goshtasbi; Arash Abiri; Brandon M Lehrich; Yarah M Haidar; Tjoson Tjoa; Edward C Kuan Journal: Head Neck Date: 2021-05-17 Impact factor: 3.821
Authors: Sarah R Akkina; Roderick Y Kim; Chaz L Stucken; Melissa A Pynnonen; Carol R Bradford Journal: Laryngoscope Investig Otolaryngol Date: 2018-08-09