Kidney CancerTreatment Facility Volume and Survival in Patients with Metastatic Renal Cell Carcinoma: A Registry-based Analysis
Introduction
Although mortality rates for patients with renal cell carcinoma (RCC) have declined over several decades, survival following the diagnosis of metastatic RCC (mRCC) continues to be poor [1]. Metastatic RCC is often an aggressive disease that is poorly responsive to traditional cytotoxic systemic therapies, with the 5-yr overall survival (OS) for patients as low as 8%, leading to over 14 000 deaths from RCC annually [1], [2].
The landscape for systemic mRCC therapy has rapidly evolved over the last 10 yr, first with improvements in targeted therapies and more recently with the development of novel immunotherapies. Advanced knowledge of these ever-changing treatment options may be necessary to obtain optimal patient outcomes. Centers that manage higher volumes of cancer patients likely employ providers that have such advanced knowledge and treatment experience, as well as access to novel drugs via clinical trials. Indeed, treatment volume has historically been used as a surrogate marker for hospital and provider experience, and may also indicate the presence of more streamlined care processes that can impact patient outcomes.
The volume-outcome relationship of various medical treatments and procedures has long been established, although the magnitude of this association varies greatly [3], [4]. This relationship also appears to hold true for cancer therapies, with mounting evidence to suggest that treatment facilities (TFs) that manage a higher volume of cancer patients might have improved survival outcomes [5], [6], [7], [8], [9].
For RCC, the volume-outcome relationship has been explored for the treatment of localized disease. Many studies have demonstrated that high-volume TFs lead to improved postoperative outcomes and fewer complications following renal cancer surgery [10], [11], [12]. Several studies showed improved in-hospital survival following high-risk nephrectomy for RCC, although it is unclear if surgery at high-volume surgical centers necessarily translates to overall longer-term survival [13], [14]. However, there is little knowledge regarding the volume-outcome relationship for patients diagnosed with and treated for mRCC. We, therefore, analyzed a large national cancer database to determine if there is a relationship between TF volume and survival outcomes for patients diagnosed with mRCC.
Section snippets
Data source
The National Cancer Database (NCDB), a program of the ACS CoC (Commission on Cancer) and the American Cancer Society, is a national cancer registry and comprehensive clinical surveillance resource for cancer care in the USA. The NCDB compiles data from over 1500 commission-accredited cancer programs in the USA and Puerto Rico, and captures approximately 70% of all newly diagnosed cancer cases [15]. The use of national deidentified registry data was exempt from institutional review board
Patient characteristics
A total of 41 836 mRCC patients were treated at 1222 TFs (Table 1). The median patient age was 65 yr, and men comprised 66% of the cohort. Of the patients, 86% were Caucasian and 10% African American. Of the patients, 79% had clear cell mRCC, followed by 17% having “other mRCC,” 3.5% papillary mRCC, and 0.7% chromophobe mRCC. The majority of patients had a Charlson-Deyo comorbidity score of “0.”
Treatment and facility characteristics
A large proportion of patients lived in large metropolitan areas (47%), followed by small
Discussion
The management of mRCC is becoming increasingly complex, and understanding the optimal environment for care delivery and resource utilization for patients diagnosed with this aggressive and relatively uncommon disease is important. Our retrospective analysis of 41 836 patients in the NCDB finds that for patients presenting with mRCC, overall mortality decreased as TF volume increased (5 pts/yr, HR = 0.92; 10 pts/yr, HR = 0.84; 20 pts/yr, HR = 0.74). The OS benefit resulting from higher TF volume
Conclusions
Higher facility volume is associated with improvements in survival for patients being treated for mRCC. This association was strengthened as TF volume increased. These findings may help define the optimal treatment environment for the management of patients with mRCC. The improved survival outcomes at higher-volume TFs should also be a call to improve mRCC management at lower-volume facilities. Given the negative externalities of care regionalization, focus should shift toward policies that
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2023, Surgery (United States)Citation Excerpt :It has been shown that patients with HCC or BTC who undergo resection at high-volume facilities have superior postoperative outcomes when compared with patients treated at facilities with lower surgical volumes.5–7 In addition, several studies have demonstrated an associated improvement in the survival of patients who received treatment at facilities with high total institutional volume for a nonoperatively managed localized or advanced lung, ovarian, skin, laryngeal, kidney, or prostate cancer.8–13 To our knowledge, there is a lack of studies examining the association between total facility volume and survival outcomes for patients with nonoperatively managed HCC or BTC.
Association Between Surgical Volume and Survival Among Patients With Variant Histologies of Bladder Cancer
2022, UrologyCitation Excerpt :This suggests that provider and facility familiarity with variant histology are critical components in patient management and outcome. Within urology, the hospital or surgeon-volume relationship has been demonstrated for patients undergoing radical cystectomy and nephrectomy.16-18 Improved surgical expertise has been determined as a major factor in improved survival due to lower complication rates, fewer blood transfusions, and decreased length of stay.17,19