title: Impact of treating facilities' volume on survival for early-stage laryngeal cancer.
abstract: BACKGROUND
  Treatment at a high-volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from laryngeal cancer has not been examined previously.
  
  
  METHODS
  A total of 11,446 early-stage laryngeal cancer patients (1996-1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival.
  
  
  RESULTS
  Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04-1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69-0.80).
  
  
  CONCLUSIONS
  This study is the first to assess the relationship between survival and treatment volume in laryngeal cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection.
authors.affiliation: Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA. achen@emory.edu
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Alex
authors.initials: A
authors.lastname: Pavluck
authors.forename: Michael
authors.initials: M
authors.lastname: Halpern
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ward