In a study reported in JCO Oncology Practice, Villano et al found that increased hospital surgical volume was associated with overall improved survival in patients undergoing surgery for retroperitoneal soft-tissue sarcoma. However, increased volume was associated with poorer survival in patients treated at community centers vs academic centers.
Study Findings
The study used data from 10,113 patients undergoing surgical treatment of retroperitoneal soft-tissue sarcoma identified from the National Cancer Database for 2004 through 2015.
KEY POINTS
- Patient-level factors that significantly predicted worse overall survival included increasing age, non-private insurance, low income, and more comorbidities.
- Sarcoma-related factors that significantly predicted worse overall survival included specific tumor histology, higher tumor stage, and higher tumor grade.
- Treatment-level factors significantly predictive of worse overall survival included R2 vs R0/1 resection.
- Annual surgical volume was associated with a dose-dependent improvement in survival; however, compared with academic centers, risk of death in patients treated at community centers increased significantly with increasing surgical volume.
Patient-level factors that significantly (all P < .05) predicted worse overall survival included increasing age, nonprivate insurance, low income, and more comorbidities.
Sarcoma-related factors that significantly predicted worse overall survival included specific tumor histology (malignant peripheral nerve sheath tumor vs leiomyosarcoma: hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.47–2.64), higher tumor stage (stage IV vs stage I: HR = 2.89, 95% CI = 2.46–3.40), and higher tumor grade (undifferentiated vs well-differentiated: HR = 2.34, 95% CI = 2.03–2.70).
Treatment-level factors significantly predictive of worse overall survival included R2 vs R0/1 resection (HR = 2.80, 95% CI = 2.36–3.33).
Academic/research hospitals had the longest median survival time (92.1 months), with community hospitals having the lowest (76.6 months; P < .01). Annual surgical volume was associated with a dose-dependent improvement in survival, with patients treated at hospitals with an annual average of 6 to 10 cases having a median survival time of 101.7 months. However, compared with academic centers, risk of death in patients treated at community centers increased significantly with increasing surgical volume (HR = 1.26, 95% CI = 1.03–1.53). The hazard ratio for comprehensive community centers vs academic centers was 1.08 (95% CI = 1.01–1.15).
The investigators concluded, “Hospital factors affect mortality after surgical treatment of retroperitoneal soft-tissue sarcoma. Specifically, hospital type alters the surgical volume-outcome relationship for retroperitoneal soft-tissue sarcoma mortality such that community centers perform worse with increasing volumes. Recommendations that higher surgical volume improves outcomes cannot be applied universally and must be reexamined in other complex surgical cancers.”
Waddah B. Al-Refaie, MD, of the Department of Surgery, MedStar-Georgetown University Hospital, Lombardi Cancer Center, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by a grant from the Georgetown-Howard Universities Center for Clinical and Translational Science and The Lee Folger Foundation. For full disclosures of the study authors, visit ascopubs.org.
