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<p>Treatment at high-volume facilities (HVFs) has been associated with improved survival of patients with thyroid cancer undergoing treatment with curative intent. The influence of facility volume on overall survival (OS) of patients with thyroid cancer undergoing palliative treatment is unknown. To investigate the impact of facility volume on OS in patients with thyroid cancer undergoing palliative treatment. The 2004 to 2018 National Cancer Database was queried for patients with thyroid cancer undergoing palliative treatment (N = 1,320). Patients were stratified based on facility volume percentile. Multivariable binary logistic and Cox proportional hazards regression models were implemented. Of 503 facilities included, 252 (50.1%), 121 (24.1%), 69 (13.7%), 41 (8.2%), and 20 (4.0%) had volume &lt; 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentiles, respectively. Patients with anaplastic (aHR 0.52, 95% CI 0.37–0.73, <i>P</i> &lt; 0.001), poorly differentiated (aHR 0.38, 95% CI 0.22–0.65, <i>P</i> &lt; 0.001), or cT4 (aHR 0.44, 95% CI 0.26–0.77, <i>P</i> = 0.004) disease were less likely to receive palliative treatment at a facility with volume ≥ 80th percentile. 5-year OS of patients undergoing palliative treatment at facilities with volume &lt; 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentile was 12%, 17%, 13%, 20%, and 30%, respectively (<i>P</i> &lt; 0.001). Facilities with volume ≥ 80th percentile (aHR 0.76, 95% CI 0.64–0.89, <i>P</i> &lt; 0.001) were associated with higher 5-year OS. Undergoing palliative treatment at HVFs is associated with higher OS in patients with thyroid cancer. The survival benefit derived from HVFs should be contextualized with other patient and facility factors affecting access and delivery of palliative services. Level of Evidence: 4.</p>

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Impact of Facility Volume on Overall Survival in Patients with Thyroid Cancer Undergoing Palliative Treatment

  • 期刊论文

  • 发表日期：

    2025年11月5日

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  • Hamail Iqbal,
  • Aman M. Patel,
  • David W. Wassef,
  • Rohini Bahethi,
  • Paul T. Cowan,
  • Soly Baredes,
  • Richard Chan Woo Park

摘要

Treatment at high-volume facilities (HVFs) has been associated with improved survival of patients with thyroid cancer undergoing treatment with curative intent. The influence of facility volume on overall survival (OS) of patients with thyroid cancer undergoing palliative treatment is unknown. To investigate the impact of facility volume on OS in patients with thyroid cancer undergoing palliative treatment. The 2004 to 2018 National Cancer Database was queried for patients with thyroid cancer undergoing palliative treatment (N = 1,320). Patients were stratified based on facility volume percentile. Multivariable binary logistic and Cox proportional hazards regression models were implemented. Of 503 facilities included, 252 (50.1%), 121 (24.1%), 69 (13.7%), 41 (8.2%), and 20 (4.0%) had volume < 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentiles, respectively. Patients with anaplastic (aHR 0.52, 95% CI 0.37–0.73, P < 0.001), poorly differentiated (aHR 0.38, 95% CI 0.22–0.65, P < 0.001), or cT4 (aHR 0.44, 95% CI 0.26–0.77, P = 0.004) disease were less likely to receive palliative treatment at a facility with volume ≥ 80th percentile. 5-year OS of patients undergoing palliative treatment at facilities with volume < 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentile was 12%, 17%, 13%, 20%, and 30%, respectively (P < 0.001). Facilities with volume ≥ 80th percentile (aHR 0.76, 95% CI 0.64–0.89, P < 0.001) were associated with higher 5-year OS. Undergoing palliative treatment at HVFs is associated with higher OS in patients with thyroid cancer. The survival benefit derived from HVFs should be contextualized with other patient and facility factors affecting access and delivery of palliative services. Level of Evidence: 4.