The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma

Abstract

Objective. To evaluate differences in treatment outcomes for head and neck mucosal melanoma (HNMM) patients seen at academic versus nonacademic centers and high versus low volume facilities.Study Design. Retrospective cohort study.Setting. National Cancer Database.Methods. Differences in treatment course and overall survival (OS) by facility type and volume were assessed for 2772 HNMM cases reported by the 2004 to 2017 National Cancer Database. A subgroup analysis was performed with a smaller cohort containing staging data. The analysis employed Kaplan-Meier and Cox proportional hazards models.Results. A higher proportion of patients treated at academic centers within the HNMM cohort waited longer for surgery after diagnosis (p < .001), had negative surgical margins (p < .001), and were readmitted to the hospital within 30 days of surgery (p = .001); these relationships remained significant when controlling for cancer stage. Kaplan-Meier analysis demonstrated higher 5-year OS for patients treated at academic versus nonacademic facilities within the main cohort (32.5% ± 1.3% vs 27.3% ± 1.5%; p = .006) and within the stagecontrolled subgroup (34.8% ± 2.1% vs 27.2% ± 2.6%; p = .003). Treatment at high volume versus low volume facilities was associated with improved 5-year OS for main cohort patients (33.5% ± 1.7% vs 28.8% ± 1.2%; p = .016) but not for subgroup patients (35.3% ± 2.7% vs 30.1% ± 2.1%; p = .100). Upon multivariate analysis controlling for demographic and oncologic factors, there was no significant difference in OS by facility type (main cohort: odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.01-1.21; subgroup: OR = 1.13, 95% CI = 0.97-1.32). Conclusion.Neither facility type nor surgical volume predicts overall survival in HNMM.

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

“…The association between academic facility and higher OS has been documented in several head and neck cancers. [59][60][61][62][63][64][65][66][67][68][69][70] Medicaid and nodal metastasis portended poorer OS, consistent with previously established prognostic factors in MSGC. [50][51][52][53][54][55] Surgical resection is the preferred definitive treatment of MSGC classified as cT4a or lower.…”

“…These factors are likely responsible for most patients (57.2%) with cT4b MSGC undergoing definitive treatment at academic facilities. The association between academic facility and higher OS has been documented in several head and neck cancers 59‐70 . Medicaid and nodal metastasis portended poorer OS, consistent with previously established prognostic factors in MSGC 50‐55 …”

“…Nine hundred and seventy-six patients with cT4b MSGC satisfied the inclusion criteria (Table 1). Median age (interquartile range [IQR]) was 66 (56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75) years. Most patients were male (62.6%), white (81.1%), treated at academic facilities (54.2%), had high-grade tumors (69.3%), and presented with nodal (52.6%) or distant metastases (22.7%).…”

The impact of facility type and volume on treatment and overall survival in craniopharyngioma

“…Though it may not always be the case, academic centers are likely to encounter a higher volume of craniopharyngioma cases due to the complexity of their treatment, which typically includes surgical resection with the addition of chemotherapy and/or radiation. 7,23,24 This is due in part to the invasive nature of the tumor with involvement of nearby critical neurovascular and neuroendocrine structures. Surgical and adjuvant treatment planning is paramount for successful control of craniopharyngioma requiring collaboration by an expert multidisciplinary team and resources to treat these complex skull base lesions.…”

Facility type and cancer outcomes in the United States

“…It should be noted that cancers with the greatest benefit from high-volume facilities were those with the highest number of cancer-related deaths, including cancers of the pancreas, esophagus, and brain ( 23 ). Select studies have shown poorer survival at large institutions, possibly due to the complexity of patients referred to and treated at these centers ( 24 ).…”