The association between facility volume and overall survival in patients with Merkel cell carcinoma.
Journal of surgical oncology
BACKGROUND: Merkel cell carcinoma is an uncommon malignancy often requiring multidisciplinary management. The purpose of this study was to determine whether high-volume facilities have improved outcomes in patients with Merkel cell carcinoma relative to lower-volume facilities.
METHODS: A total of 5304 patients from the National Cancer Database with stage I-III Merkel cell carcinoma undergoing surgery were analyzed. High-volume facilities were the top 1% by case volume. Multivariable Cox regression and propensity score-matching were performed to account for imbalances between groups.
RESULTS: Treatment at high-volume facilities (hazard ratio: 0.74; 95% confidence interval: 0.65-0.84, P < .001) was independently associated with improved overall survival (OS) in multivariable analyses. In propensity score-matched cohorts, 5-year OS was 62.3% at high-volume facilities vs 56.8% at lower-volume facilities (P < .001). Median OS was 111 months at high-volume facilities vs 79 months at lower-volume facilities.
CONCLUSION: Treatment at high-volume facilities is associated with improved OS in Merkel cell carcinoma. Given the impracticality of referring all elderly patients with Merkel cell carcinoma to a small number of facilities, methods to mitigate this disparity should be explored.
Yoshida, Emi J; Luu, Michael; Freeman, Morganna; Essner, Richard; Gharavi, Nima M; Shiao, Stephen L; Mallen-St Clair, Jon; Hamid, Omid; Ho, Allen S; and Zumsteg, Zachary S, "The association between facility volume and overall survival in patients with Merkel cell carcinoma." (2020). Articles, Abstracts, and Reports. 3050.