Does Children's Oncology Group hospital membership improve survival for patients with neuroblastoma or Wilms tumor?
OBJECTIVE
To determine prognostic significance of hospital surgical volume and Children's Oncology Group (COG) membership on neuroblastoma (NBL) and Wilms tumor (WT) survival.


METHODS
The Florida Cancer Data System was queried from 1981 to 2004.


RESULTS
Of 869 NBL patients, 463 were treated at COG/HVC, 246 at COG/LVC, and 160 at non-COG/LVC. COG hospitals treated a larger proportion of patients <1 year of age (P = 0.002) and relatively more patients with adrenal and mediastinal tumors (P = 0.005). COG centers more frequently administered chemotherapy (72% vs. 51%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (70.6%, 67.7%) and COG/LVC (75.8%, 72.6%) than non-COG/LVC (59.5%, 54.4%, P < 0.05). Of 790 WT patients, 395 were treated at COG/HVC, 210 at COG/LVC, and 185 at non-COG/LVC. COG hospitals treated younger patients and lower staged tumors (P < 0.05). COG centers more frequently administered chemotherapy (88% vs. 59%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (91.3%, 89.9%) and COG/LVC (96.7%, 94.7%) than non-COG/LVC (82.4%, 81.7%, P < 0.05). Multivariate analysis demonstrated WT patients treated at non-COG hospitals, but not NBL patients, had worse survival (HR 3.107, P = 0.01).


CONCLUSIONS
Children treated at COG hospitals had higher overall use of chemotherapy. This translated into a significantly improved survival benefit for WT.
Gutierrez
Juan C
JC
Division of Pediatric Surgery and Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Cheung
Michael C
MC
Zhuge
Ying
Y
Koniaris
Leonidas G
LG
Sola
Juan E
JE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D009447:Neuroblastoma / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D015996:Survival Rate; D009396:Wilms Tumor / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery