The association between nephroblastoma-specific outcomes and high versus low volume treatment centers

Morgan K. Richards*, Adam B. Goldin, Alexandra Savinkina, John Doski, Melanie Goldfarb, Jed Nuchtern, Monica Langer, Elizabeth A. Beierle, Sanjeev Vasudevan, Kenneth W. Gow, Mehul V Raval

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background Though the volume-outcome relationship has been well-established in adults, low mortality rates and small sample sizes have precluded definitive demonstration in children. This study compares treatment-specific factors for children with nephroblastoma at high (HVC) versus low volume centers (LVC). Methods We performed a retrospective cohort study comparing patients ≤ 18 years with unilateral nephroblastoma treated at HVCs and LVCs using the National Cancer Data Base (1998–2012). Definitions of HVCs included performing above the median, the upper two quartiles, and the highest decile of nephroblastoma resections. Outcomes included nodal sampling, margin status, time to chemotherapy and radiation, and survival. Statistical analyses included χ2, t-tests, generalized linear, and Cox regression models (p < 0.05). Results Of 2911 patients from 210 centers, 1443 (49.6%) were treated at HVCs. There was no difference in frequency of preoperative biopsy or days to radiation (p > 0.05). High volume centers were more likely to perform nodal sampling (RR 1.04, 95%CI 1.01–1.08) and had fewer days to chemotherapy (RR 0.80, 95%CI 0.69–0.93). Five-year survival was similar (HVC: 0.93, 95%CI 0.92–0.94; LVC: 0.93, 95%CI 0.91–0.94). Conclusions HVCs were more likely to perform nodal sampling and had fewer days to chemotherapy. There was no difference in days to radiation or survival between centers. Level of evidence Level II (retrospective prognosis study).

Original languageEnglish (US)
Pages (from-to)104-108
Number of pages5
JournalJournal of pediatric surgery
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • National Cancer Data Base
  • Nephroblastoma
  • Volume-outcome
  • Wilms’ tumor

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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