Patients with hepatocellular carcinoma seen at a high-volume hospital had improved overall survival vs. patients seen at a low-volume hospital, according to published findings.
“Our study is the first to demonstrate that hospital volumes are associated with better survival for both surgical and nonsurgical patients with [hepatocellular carcinoma],” Adam C. Yopp, MD, of the department of surgery, division of digestive and liver diseases, University of Texas Southwestern Medical Center, and colleagues wrote. “We found that patients at high-volume centers were more likely to present with localized tumors, more likely to undergo curative treatment and had significantly better survival.”
The researchers evaluated 17,231 patients with HCC from 322 hospitals found in the Texas Cancer Registry between 2000 and 2011. They used Contal’s outcome-based method to divide hospital volume by low and high parameters. To stratify between high- and low-volume hospitals, researchers adopted an annual hospital volume cutoff point of 24 patients.
Results showed patients at high-volume hospitals were more likely to have localized disease (56%) compared with those seen at low-volume hospitals (50%; P < .01). Patients at high-volume hospitals were also more likely to receive curative therapies such as surgical resection, liver transplantation or ablation (22%) compared with patients seen at low-volume hospitals (12%; P < .01).
High-volume hospitals were significantly associated with improved survival (HR = 0.96; 95% CI, 0.94–0.98), even after adjusting for patient demographics, socioeconomic status, tumor stage and year of HCC diagnosis. Hospital volume was associated with increased overall treatment use in patients with localized disease (OR = 1.3; 95% CI, 1.2–1.4) and regional disease (OR = 1.20; 95% CI, 1.09-1.33), but not with metastatic disease (OR = 1.08; 95% CI, 0.99-1.17).
“Our results support and expand on prior reports demonstrating an association between hospital volume and survival in patients with HCC,” the researchers concluded. “This benefit is particularly evident among those with localized or regional disease likely related to improved administration of HCC-directed therapy.” – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.