Association between Treatment at High-Volume Facilities and Improved Overall Survival in Soft Tissue Sarcomas

Publication date: Available online 21 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sriram Venigalla, Kevin T. Nead, Ronnie Sebro, David M. Guttmann, Sonam Sharma, Charles B. Simone, William P. Levin, Robert J. Wilson, Kristy L. Weber, Jacob E. Shabason
BackgroundSoft tissue sarcomas (STS) are rare malignancies requiring complex multidisciplinary management. Therefore, facilities with high sarcoma case volume may demonstrate superior outcomes. We hypothesized that STS treatment at high-volume facilities is associated with improved overall survival (OS).MethodsPatients ≥18 years with non-metastatic STS treated with surgery and radiotherapy at a single facility from 2004-2013 were identified from the National Cancer Database (NCDB). Facilities were dichotomized into high-volume (HV) and low-volume (LV) cohorts based on total case volume over the study period. OS was assessed using multivariable Cox regression with propensity-score matching. Patterns of care were assessed using multivariable logistic regression analysis.ResultsOf 9,025 total patients, 1,578 (17%) and 7,447 (83%) were treated at HV and LV facilities, respectively. On multivariable analysis, high educational attainment, larger tumor size, higher grade, and negative surgical margins were statistically significantly associated with treatment at HV facilities; conversely, black race and non-metropolitan residence were negative predictors of treatment at HV facilities. On propensity-score matched multivariable analysis, treatment at HV facilities versus LV facilities was associated with improved OS (hazard ratio (HR) = 0.87, 95% CI: 0.80-0.95, p = 0.001). Older age, lack of insurance, greater comorbidity, larger tumor size, higher tumor grade, and positive surgical margins were associated with statistically significantly worse OS.ConclusionsIn this observational cohort study using the NCDB, receipt of surgery and radiotherapy at HV facilities was associated with improved OS for patients with STS. Potential socio-demographic disparities limit access to care at HV facilities for certain populations. Our findings highlight the importance of receipt of care at HV facilities for patients with STS, and warrant further study into improving access to care at HV facilities.

Teaser

Patients with soft tissue sarcomas, a group of rare malignancies that require complex management, may benefit from care at high-volume treatment facilities as such facilities may offer greater physician expertise, superior resource availability, and delivery of highly coordinated care. Using the National Cancer Database, we demonstrate an association between high facility case volume and overall survival in patients with soft tissue sarcomas; these findings support centralization of care for sarcomas.


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