The association between facility volume and overall survival in patients with Merkel cell carcinoma.

Autor: Yoshida EJ; Department of Radiation Oncology, University of California San Francisco, San Francisco, California., Luu M; Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California., Freeman M; Department of Medical Oncology, City of Hope, Duarte, California., Essner R; John Wayne Cancer Institute, Providence St. John's Health Center, Santa Monica, California., Gharavi NM; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California., Shiao SL; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California., Mallen-St Clair J; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Surgery, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California., Hamid O; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Medical Oncology, The Angeles Clinic and Research Institute, Los Angeles, California., Ho AS; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Surgery, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California., Zumsteg ZS; Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2020 Aug; Vol. 122 (2), pp. 254-262. Date of Electronic Publication: 2020 Apr 15.
DOI: 10.1002/jso.25931
Abstrakt: Background: Merkel cell carcinoma is an uncommon malignancy often requiring multidisciplinary management. The purpose of this study was to determine whether high-volume facilities have improved outcomes in patients with Merkel cell carcinoma relative to lower-volume facilities.
Methods: A total of 5304 patients from the National Cancer Database with stage I-III Merkel cell carcinoma undergoing surgery were analyzed. High-volume facilities were the top 1% by case volume. Multivariable Cox regression and propensity score-matching were performed to account for imbalances between groups.
Results: Treatment at high-volume facilities (hazard ratio: 0.74; 95% confidence interval: 0.65-0.84, P < .001) was independently associated with improved overall survival (OS) in multivariable analyses. In propensity score-matched cohorts, 5-year OS was 62.3% at high-volume facilities vs 56.8% at lower-volume facilities (P < .001). Median OS was 111 months at high-volume facilities vs 79 months at lower-volume facilities.
Conclusion: Treatment at high-volume facilities is associated with improved OS in Merkel cell carcinoma. Given the impracticality of referring all elderly patients with Merkel cell carcinoma to a small number of facilities, methods to mitigate this disparity should be explored.
(© 2020 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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