Treatment at a high-volume centre is associated with improved survival among patients with non-metastatic hepatocellular carcinoma

Background & AimsThe association between case volume and outcomes is well-documented for several cancer types. However, it is unknown if patients with hepatocellular carcinoma treated at high-volume centres have improved overall survival. MethodsAbout 135442 patients diagnosed with hepatocellular carcinoma between 2004-2014 were identified in the Commission on Cancer's National Cancer Database and 53795 patients were excluded for metastatic or node-positive disease. Average annual case volume was calculated as the total number of cases treated per centre from 2004-2014 and dividing by 10. Receiver operating characteristic curves showed the most significant case number threshold between high-volume centres and remaining centres. Univariate and multivariate analyses were performed using Cox regression analysis to determine factors associated with improved survival. Kaplan-Meier curves and log-rank tests were used for overall survival estimates. ResultsA total of 81647 patients with stage I-III hepatocellular carcinoma were treated at a total of 1218 centres. The median [range] case volume per year averaged over the 10-year study period was 48.6 [0.1-205.5]. High-volume centres treated >114 cases of hepatocellular carcinoma annually while remaining centre treated 114 cases. Median survival for patients treated in high-volume centres and remaining centres were 31.9 and 16.6months respectively (Log Rank P<.001). On multivariate analysis, average annual case volume was significantly associated with improved survival. ConclusionsReceiving treatment at a high-volume centre is significantly associated with survival for patients with non-metastatic disease. Improved survival at high-volume centres may be related to access to a variety of treatment modalities, multidisciplinary evaluation, and/or subspecialty expertise.