The Impact of Academic Facility Type and Case Volume On Survival in Patients Undergoing Curative Radiotherapy for Muscle-Invasive Bladder Cancer

Publication date: Available online 5 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Amishi Bajaj, Brendan Martin, Richa Bhasin, Courtney Hentz, Alec M. Block, Matthew M. Harkenrider, Abhishek A. Solanki
BackgroundBladder-preserving curative radiation therapy (RT) has been established as an excellent treatment option for select patients with muscle-invasive bladder cancer (MIBC). However, some clinicians have concern that good outcomes are only achievable at high volume facilities and academic centers, questioning successful reproducibility of curative RT at smaller centers. The present study sought to determine if treatment at academic centers (AC) or high-volume facilities (HVF) was associated with better overall survival (OS) than treatment at non-academic centers (NAC) or lower-volume facilities (LVF).Materials and MethodsWe performed a retrospective cohort study of National Cancer Database (NCDB) patients (n=2,763) with cT2-4 N0 M0 transitional cell MIBC who received curative RT (60-70 Gy) with or without concurrent chemotherapy. Cox proportional hazards models were used to estimate the instantaneous hazard of death as a function of univariable and multivariable patient characteristics and clinical measures.ResultsUnivariable analysis (UVA) demonstrated that academic facility type was significantly associated with improved OS (HR = 0.88, 95% CI: 0.79-0.98, p=.02), while higher case volume was not associated with improved survival (HR = 0.97, 95% CI: 0.92-1.01, p=.15). MVA revealed no differences in OS for treatment at AC vs. NAC (HR = 0.94, 95% CI: 0.84-1.06; p=.31) or HVF vs. LVF (HR = 0.99, 95% CI: 0.94-1.04; p = .60). 2-year OS was 54.5% (95% CI: 52.5-56.4%) and 5-year OS was 28.9% (95% CI: 27.0-30.8%).ConclusionsAlthough some providers are cautious about offering curative radiotherapy at all centers, this large hospital-based study suggests that facility type and volume are not significantly associated with OS for patients undergoing curative RT after accounting for other clinically relevant risk factors. The results of this study demonstrate that curative RT in the treatment of MIBC may be considered for patients regardless of facility type or volume.

Teaser

We conducted a retrospective cohort study of patients in the National Cancer Database with muscle-invasive bladder cancer undergoing curative radiotherapy to identify whether the facility type and treating facility's case volume impact survival outcomes. When controlling for disease extent and treatment characteristics, patients at academic and non-academic facilities and low and high volume facilities had similar survival outcomes. Thus bladder-sparing curative radiotherapy should be discussed and offered confidently at most centers.


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