Treatment at a high‐volume centre is associated with improved survival among patients with non‐metastatic hepatocellular carcinoma

摘要

Abstract Background & Aims The association between case volume and outcomes is well‐documented for several cancer types. However, it is unknown if patients with hepatocellular carcinoma treated at high‐volume centres have improved overall survival. Methods About 135?442 patients diagnosed with hepatocellular carcinoma between 2004‐2014 were identified in the Commission on Cancer's National Cancer Database and 53?795 patients were excluded for metastatic or node‐positive disease. Average annual case volume was calculated as the total number of cases treated per centre from 2004‐2014 and dividing by 10. Receiver operating characteristic curves showed the most significant case number threshold between high‐volume centres and remaining centres. Univariate and multivariate analyses were performed using Cox regression analysis to determine factors associated with improved survival. Kaplan‐Meier curves and log‐rank tests were used for overall survival estimates. Results A total of 81?647 patients with stage I‐ III hepatocellular carcinoma were treated at a total of 1218 centres. The median [range] case volume per year averaged over the 10‐year study period was 48.6 [0.1‐205.5]. High‐volume centres treated 114 cases of hepatocellular carcinoma annually while remaining centre treated ≤114 cases. Median survival for patients treated in high‐volume centres and remaining centres were 31.9 and 16.6?months respectively (Log Rank P ??.001). On multivariate analysis, average annual case volume was significantly associated with improved survival. Conclusions Receiving treatment at a high‐volume centre is significantly associated with survival for patients with non‐metastatic disease. Improved survival at high‐volume centres may be related to access to a variety of treatment modalities, multidisciplinary evaluation, and/or subspecialty expertise.