title: Impact of Facility Type and Surgical Volume on 10-Year Survival in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma.
abstract: BACKGROUND
  Previous studies have demonstrated improved in-hospital mortality after hepatic resection for hepatocellular carcinoma (HCC) at teaching hospitals. The objective of this study was to evaluate if resection of HCC at academic cancer programs (ACP) is associated with improved 10-year survival.
  
  
  METHODS
  Using the National Cancer Data Base (NCDB) (1998 to 2011), we evaluated patients undergoing hepatic resection for HCC at ACPs, comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). High volume cancer programs (HVCPs) were defined as performing 10 or more hepatectomies per year. Multivariate Cox proportional hazard models by stepwise selection were applied to estimate hazard ratios (HR) of predictors of survival. The Kaplan-Meier method was used to generate survival curves at each facility type, and survival rates were compared using the log-rank test.
  
  
  RESULTS
  We identified 12,757 patients undergoing hepatic resection for HCC at ACPs (n = 8,404), CCPs (n = 483), and CCCPs (n = 3,870). Sixty-two percent (n = 5,191) of patients treated at ACPs were at high volume institutions compared with 11.6% (n = 446) and 0% of CCCPs and CCPs, respectively (p < 0.0001). On multivariable analysis, patients undergoing hepatic resection at transplant centers (p < 0.0001) and HVCPs had significantly improved survival (p < 0.0001). Adjusted 10-year survival rates were 28.7% at high volume ACPs, 28.2% at high volume CCCPs, 24.9% at low volume CCCPs, 25.1% at low volume ACPs, and 21.3% at CCPs (p ≤ 0.0001).
  
  
  CONCLUSIONS
  Patients undergoing hepatic resection for HCC at HVCPs had a significantly improved 10-year survival. Regionalization of HCC treatment to HVCPs may improve long-term survival.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Chapman
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paniccia
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hosokawa
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO.
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Overbey
authors.affiliation: Department of Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Wells
authors.initials: W
authors.lastname: Messersmith
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Martin D
authors.initials: MD
authors.lastname: McCarter
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Ana
authors.initials: A
authors.lastname: Gleisner
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO. Electronic address: Csaba.Gajdos@ucdenver.edu.
authors.forename: Csaba
authors.initials: C
authors.lastname: Gajdos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States