Impact of facility type and volume in low-grade glioma outcomes.

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2019
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Abstract
The object of this study was to investigate the impact of facility type (academic center [AC] vs non-AC) and facility volume (high-volume facility [HVF] vs low-volume facility [LVF]) on low-grade glioma (LGG) outcomes.This retrospective cohort study included 5539 LGG patients (2004-2014) from the National Cancer Database. Patients were categorized by facility type and volume (non-AC vs AC, HVF vs LVF). An HVF was defined as the top 1% of facilities according to the number of annual cases. Outcomes included overall survival, treatment receipt, and postoperative outcomes. Kaplan-Meier and Cox proportional-hazards models were applied. The Heller explained relative risk was computed to assess the relative importance of each survival predictor.Significant survival advantages were observed at HVFs (HR 0.67, 95% CI 0.55-0.82, p < 0.001) and ACs (HR 0.84, 95% CI 0.73-0.97, p = 0.015), both prior to and after adjusting for all covariates. Tumor resection was 41% and 26% more likely to be performed at HVFs vs LVFs and ACs vs non-ACs, respectively. Chemotherapy was 40% and 88% more frequently to be utilized at HVFs vs LVFs and ACs vs non-ACs, respectively. Prolonged length of stay (LOS) was decreased by 42% and 24% at HVFs and ACs, respectively. After tumor histology, tumor pattern, and codeletion of 1p19q, facility type and surgical procedure were the most important contributors to survival variance. The main findings remained consistent using propensity score matching and multiple imputation.This study provides evidence of survival benefits among LGG patients treated at HVFs and ACs. An increased likelihood of undergoing resections, receiving adjuvant therapies, having shorter LOSs, and the multidisciplinary environment typically found at ACs and HVFs are important contributors to the authors' finding.
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Authors Zhu, Ping;Du, Xianglin L;Blanco, Angel I;Ballester, Leomar Y;Tandon, Nitin;Berger, Mitchel S;Zhu, Jay-Jiguang;Esquenazi, Yoshua;
Journal journal of neurosurgery
Year 2019
DOI 10.3171/2019.6.JNS19409
URL
Keywords
oncology low-grade glioma ac = academic center crt = chemoradiation eor = extent of resection gtr = gross-total resection hvf = high-volume facility lgg = low-grade glioma los = length of stay lvf = low-volume facility ncdb = national cancer database national cancer database os = overall survival psm = propensity score matching rt = radiation therapy str = subtotal resection us = united states hospital based overall survival volume based

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