The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

BACKGROUND: This study evaluates the influence of facility case-volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS). METHODS: The 2004-2015 National Cancer Database was queried for NPC patients receiving definitive treatment. RESULTS: A total of 8,260 patients (5-year OS: 63.4%) were included. The 1,114 unique facilities were categorized into 854 low-volume (treating 1-8 patients), 200 intermediate-volume (treating 9-23 patients), and 60 high-volume (treating 24-187 patients) facilities. Kaplan-Meier log-rank analysis demonstrated significantly improved OS with high-volume facilities (p<0.001). On cox proportional-hazard multivariate regression after adjusting for age, gender, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high-volume facilities were associated with lower mortality risk than low-volume (HR=0.865, p=0.019) and intermediate-volume facilities (HR=0.916, p=0.004). Propensity score matching analysis confirmed this association (p<0.001). CONCLUSION: Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high-volume medical centers