title: Hospital volume of percutaneous radiofrequency ablation is closely associated with treatment outcomes for patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Hospital volume for several major operations is associated with treatment outcomes. In this study, the authors explored the influence of hospital radiofrequency ablation (RFA) volume on the prognosis of patients who received RFA for hepatocellular carcinoma (HCC).
  
  
  METHODS
  The authors searched for all patients who were diagnosed with stage I or stage II HCC from 2004 to 2006 and who received RFA as first-line therapy in a population-based cohort. Overall survival (OS) and liver cancer-specific survival (CSS) were compared according to hospital volume. A Cox proportional hazards model was used for multivariate analysis.
  
  
  RESULTS
  In total, 661 patients received first-line RFA for stage I and II HCC in 28 hospitals. Among these, there were 480 patients (72.6%) in the high-volume group (those who received RFA at hospitals that treated >10 first-line patients per year), and there were 181 patients (27.4%) in the low-volume group (those who received RFA at hospitals that treated ≤ 10 first-line patients per year). The sex, age, stage, tumor size, and year of diagnosis for patients in the 2 groups did not differ significantly. Patients in the high-volume group demonstrated significantly longer OS and CSS than those in the low-volume group (5-year OS rate, 58.7% vs 47.2%; P = .001; 5-year CSS rate, 67.1% vs 57.1%; P = .009). After adjusting for covariates, high-volume hospitals remained an independent predictor of longer OS (hazard ratio, 0.57; P < .001) and CSS (hazard ratio, 0.57; P = .003).
  
  
  CONCLUSIONS
  Patients who received first-line RFA for HCC in high-volume hospitals demonstrated better survival outcomes.
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
authors.forename: Li-Chun
authors.initials: LC
authors.lastname: Lu
authors.forename: Yu-Yun
authors.initials: YY
authors.lastname: Shao
authors.forename: Raymond N C
authors.initials: RN
authors.lastname: Kuo
authors.forename: Zhong-Zhe
authors.initials: ZZ
authors.lastname: Lin
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Yeh
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Shau
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Hsu
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome