Impact of facility type and volume in low-grade glioma outcomes.
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.
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
Access
Citation
ID:
53267
References
Blockchain Verification
Account:
NFT Contract Address:
0x95644003c57E6F55A65596E3D9Eac6813e3566dA
Article ID:
53267
Unique Identifier:
10.3171/2019.6.JNS19409
Network:
Scimatic Chain (ID: 481)
Loading...
Blockchain Readiness Checklist
Authors
Abstract
Journal Name
Year
Title
Creates 1,000,000 NFT tokens for this article
Token Features:
- ERC-1155 Standard NFT
- 1 Million Supply per Article
- Transferable via MetaMask
- Permanent Blockchain Record
Scan with Saymatik Web3.0 Wallet