Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery.
Academic Medical Centers
/ statistics & numerical data
Aged
Clinical Competence
/ standards
Female
Head and Neck Neoplasms
/ mortality
Hospitals, Community
/ statistics & numerical data
Humans
Male
Middle Aged
North Carolina
/ epidemiology
Proportional Hazards Models
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
/ mortality
Survival Analysis
academic medicine, academic medical center cancer center, head and neck cancer, head and neck squameous cell carcinoma, private hospital, survival, stage
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
04
01
2019
revised:
03
04
2020
accepted:
23
04
2020
pubmed:
26
5
2020
medline:
29
1
2021
entrez:
26
5
2020
Statut:
ppublish
Résumé
To determine whether the academic affiliation or surgical volume affects the overall survival (OS) of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) patients receiving surgery. A retrospective study of 39 North Carolina Medical Centers was conducted. Treatment centers were classified as academic hospitals, community cancer centers, or community hospitals and were divided into thirds by volume. The primary outcome was 5-year OS. Hazard ratios (HR) were determined using Cox proportional hazard models, adjusting for demographics, tumor site, stage, insurance status, tobacco use, alcohol use, stage, chemotherapy, and radiation therapy. Patients were also stratified by stage (early stage and advanced stage). Patients treated at community cancer centers had significantly better 5-year OS (HR 0.68, 95% confidence interval [CI] = 0.48-0.98), and patients treated at academic hospitals trended toward better 5-year OS (HR 0.72, 95% CI = 0.50-1.04) compared to patients treated at community hospitals. The effect for academic affiliation on survival was more pronounced for patients with advanced stage cancer at diagnosis (HR 0.60, 95% CI = 0.37-0.95). There were no significant survival differences among early stage patients by treatment center type. Top-third (HR = 0.64, 95% CI = 0.42-0.96) centers by surgical volume had significantly better 5-year OS, and middle-third (HR = 0.71, 95% CI = 0.51-1.03) centers by volume trended toward better 5-year OS when compared to the bottom-third centers by volume. Patients treated at academic hospitals, community cancer centers, and hospitals in the top third by case volume have favorable survival for HPV-negative HNSCC. The effect for academic hospitals is most pronounced among advanced stage patients. 4 Laryngoscope, 131:E479-E488, 2021.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
E479-E488Subventions
Organisme : NCI NIH HHS
ID : R01 CA090731
Pays : United States
Organisme : NIDCD NIH HHS
ID : T32 DC005360
Pays : United States
Informations de copyright
© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
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