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T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment?

ABSTRACT: Recent large-scale studies have observed differences in survival following treatment for early laryngeal carcinoma depending on treatment type but were not able to take sociodemographic, comorbidity, and facility data into account. The objective of this study was to determine whether survival differences across treatment types persist when these factors are included in the analysis.Retrospective cohort analysis.Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data files.Medicare beneficiaries who were identified through the SEER registries (1991-2009) as having T1 glottic squamous cell carcinoma (scca) and a known treatment type were included.A total of 2338 patients with incident T1 glottic scca were identified. Most were white and male. Treatment type was radiation only in 47%, local surgery and radiation in 39%, and local surgery only in 14%. Black race and increased comorbidities were associated with worse survival. When sociodemographics, comorbidities, and facility characteristics were taken into account, survival differences were observed across treatment types, with those receiving local surgery demonstrating better overall and cancer-specific survival.These results suggest that following treatment of T1 glottic scca, there may be survival differences across treatment types beyond those explained by sociodemographic, comorbidity, and facility characteristics.

SUBMITTER: Misono S

PROVIDER: S-EPMC5560894 | biostudies-other | 2015 May

REPOSITORIES: biostudies-other

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Project description:BackgroundHigher treatment facility (TF) volume has been linked with improved oncologic treatment outcomes.ObjectiveTo determine the association between TF volume and overall survival in patients with metastatic renal cell carcinoma (mRCC).Design, setting, and participantsThe National Cancer Database (NCDB) was queried for all patients with mRCC with survival data available (2004-2013, cohort A). Overall survival was assessed based on TF volumes, and increasingly narrow inclusion criteria were used to confirm the cohort A association: cohort B=mRCC patients with active treatment; cohort C=mRCC patients with systemic therapy; cohort D=mRCC patients with systemic therapy at the reporting institution; and cohort E=mRCC patients with systemic therapy at the reporting institution with known liver and lung metastatic status. Sensitivity analyses were also performed on subcohorts of mRCC who never underwent a nephrectomy (C1, D1, and E1).Outcome measurements and statistical analysisThe effect of volume on time to death (from any cause) was determined using Cox regression models, adjusting for multiple clinical pathologic factors. Volume effects (assessed continuously) were modeled using flexible cubic splines, and adjusted 1-yr survivals were obtained from the model.Results and limitationsA total of 41 836 mRCC patients were treated at 1222 TFs. The median age was 65 yr. Of the patients, 66% were men and 79% had clear cell mRCC. Median TF volume was 2.2 patients per year (pts/yr). Across all cohorts, higher TF volume was associated with improved outcomes. Adjusted 1-yr survival in cohort A was 0.36 at 2 pts/yr, 0.39 at 5 pts/yr, 0.42 at 10 pts/yr, and 0.46 at 20 pts/yr, with similar magnitudes of effect in cohorts B-E. Limitations include the retrospective nature of NCDB analysis and the lack of information on treatment regimens used at specific facilities, which may explain mechanisms of effects.ConclusionsHigher facility volume is associated with improvements in survival for patients being treated for mRCC. Steps should be taken to standardize management of mRCC patients, such as evidence-based pathway development, clinical trial access, and multidisciplinary resource availability at lower-volume TFs.Patient summaryIn this report, we analyzed a large cancer database and found that patients with metastatic kidney cancer survived longer if they were managed at facilities that treated a higher volume of such patients. This information can help find the best treatment environment for patients with metastatic kidney cancer.

Project description:BackgroundDespite improvements in medical management of advanced prostate cancer (aPC), it continues to be a leading cause of cancer death in men. Contemporary management of men with aPC is complex and requires resources to be more readily available at high-volume facilities.ObjectiveTo determine the relationship between facility volume and survival in men with aPC.Design, setting, and participantsThe National Cancer Database (NCDB) was queried from 2004 to 2013 for aPC, defined as T4, N+, or M+ disease, identifying 64815 patients. Six predefined patient cohorts were evaluated. Cohort "A" included all patients with aPC. "B" cohorts included only M0 patients. "C" cohorts included only M1 patients. Facilities were divided into quartiles based on median treatment volume (patients/yr).InterventionDiagnosis and management of aPC at an NCDB-reporting facility.Outcome measurements and statistical analysisOverall survival (OS) was assessed as a function of facility volume. Multivariable Cox regression models were fitted. Cox regressions using natural cubic splines were used to test for nonlinear relationships between volume and OS.Results and limitationsOS improved as facility volume increased (top quartile vs bottom quartile, hazard ratio 0.82, 95% confidence interval 0.77-0.88, p<0.001) and was consistent across patient cohorts. Spline models demonstrate a continuous decrease in hazard of death as volume increases. Limitations include the retrospective analysis and a lack of precise treatment information.ConclusionsIn this retrospective analysis of nearly 65000 men who presented with aPC, we demonstrate an association between higher facility volume and improvements in OS. This OS advantage persisted with similar magnitudes of effect after narrowing the cohorts by disease and treatment characteristics.Patient summaryIn this retrospective review of the National Cancer Database, we analyzed the association between treatment facility volume and survival in men who are diagnosed with advanced prostate cancer. We found that survival improved as volume increased, indicating a possible imbalance of resources and expertise that favors higher-volume facilities.

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T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment?

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