Adam Mohamed Abdelgadir, Moris Dimitrios, Behrens Shay, Nussbaum Daniel P, Jawitz Oliver, Turner Megan, Lidsky Michael, Blazer Dan
Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A.
Anticancer Res. 2019 Apr;39(4):2007-2014. doi: 10.21873/anticanres.13311.
Retroperitoneal sarcomas (RPS) are rare, histologically heterogeneous, and anatomically complex tumors. National Comprehensive Cancer Network guidelines recommend evaluation and management by multidisciplinary teams with experience in sarcoma. Our aim was to determine an appropriate hospital volume threshold for the treatment of RPS.
Patients undergoing resection of RPS were identified from the National Cancer Data Base (1998-2012). Multivariable modeling with restricted cubic splines was employed to examine the association between hospital volume and survival and identify possible hospital volume threshold.
The study included 5,340 patients who underwent surgery at 909 different hospitals. Median annual volume was two cases per year. After adjustment, hospital volume was associated with improved survival (p=0.01), without cutoff. The cohort was then grouped into: Low-volume (≤5 cases/year), intermediate-volume (6-10 cases/year), and high-volume (>10 cases/year). The majority of patients were treated in low-volume hospitals (86%), compared to 9% in intermediate- and 5% in high-volume centers; 44% of patients were treated in hospitals that performed one case per year. Compared to low-volume, high-volume hospitals more often had patients with high-grade and larger tumors. Adjusted 90-day mortality was significantly lower in high- vs. low-volume hospitals (odds ratio(OR)=0.25, p=0.02). With adjustment, treatment in high- vs. low-volume hospitals was associated with lower odds of margin positivity (OR=0.58, p=0.001), and improved overall survival (hazard ratio(HR)=0.61, p=0.002).
Treatment of RPS in high-volume centers is associated with significant reduction in short-term mortality and improved long-term survival. Hospital volume may be a surrogate for the infrastructure and support necessary for the optimal management of these complex malignancies.
腹膜后肉瘤（RPS）是罕见的、组织学上异质性且解剖结构复杂的肿瘤。美国国立综合癌症网络指南建议由具有肉瘤治疗经验的多学科团队进行评估和管理。我们的目的是确定治疗RPS的合适医院病例数阈值。
从国家癌症数据库（1998 - 2012年）中识别出接受RPS切除术的患者。采用带有受限立方样条的多变量建模来研究医院病例数与生存率之间的关联，并确定可能的医院病例数阈值。
该研究纳入了在909家不同医院接受手术的5340例患者。年病例数中位数为每年2例。调整后，医院病例数与生存率提高相关（p = 0.01），无临界值。然后将队列分为：低病例数组（≤5例/年）、中等病例数组（6 - 10例/年）和高病例数组（>10例/年）。大多数患者在低病例数医院接受治疗（86%），相比之下，中等病例数医院为9%，高病例数中心为5%；44%的患者在每年仅进行1例手术的医院接受治疗。与低病例数医院相比，高病例数医院的患者更常患有高级别和较大肿瘤。高病例数医院与低病例数医院相比，调整后的90天死亡率显著更低（优势比[OR]=0.25，p = 0.02）。经调整后，在高病例数医院与低病例数医院接受治疗，切缘阳性几率更低（OR = 0.58，p = 0.001），总生存率更高（风险比[HR]=0.61，p = 0.002）。
在高病例数中心治疗RPS与短期死亡率显著降低和长期生存率提高相关。医院病例数可能是这些复杂恶性肿瘤最佳管理所需基础设施和支持的一个替代指标。
