Objectives:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receivin...Objectives:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment.Tumor size represented the largest diameter of the primary tumor.Results:A total of 89,863 patients(53.8%female)with a mean age and tumor size of(51.0±18.0)years(Mean±SD,later the same)and(19.5±13.2)mm,respectively,were included.Patients were managed at 1,241 unique facilities,categorized into 1057 low-volume(treating approximately<10 patients annually),142 intermediate-volume(treating approximately 10-30 patients annually),and 42 high-volume facilities(treating approximately 31-105 patients annually).Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization(allp<0.001).Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival(p<0.001).On multivariate Cox-regression analysis after adjusting for age,gender,Charlson-Deyo comorbidity index,tumor size,treatment type,and facility type,treatment at intermediate-volume(HR 1.238,95%CI 1.155-1.329,p<0.001)and low-volume facilities(HR=1.413,95%CI 1.306-1.528,p<0.001)were independent risk factors of all-cause mortality,while facility type was not independently associated with overall survival.Conclusion:Management and outcomes of PA appear to be dependent on the treatment facility volume,with high-volume facilities,but not necessarily facility type,being associated with improved outcomes overall.展开更多
基金National Institute of General Medical Sciences of the National Institutes of Health(Grant/Award Number:T32GM008620(AA))。
文摘Objectives:This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma(PA).Methods:The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment.Tumor size represented the largest diameter of the primary tumor.Results:A total of 89,863 patients(53.8%female)with a mean age and tumor size of(51.0±18.0)years(Mean±SD,later the same)and(19.5±13.2)mm,respectively,were included.Patients were managed at 1,241 unique facilities,categorized into 1057 low-volume(treating approximately<10 patients annually),142 intermediate-volume(treating approximately 10-30 patients annually),and 42 high-volume facilities(treating approximately 31-105 patients annually).Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization(allp<0.001).Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival(p<0.001).On multivariate Cox-regression analysis after adjusting for age,gender,Charlson-Deyo comorbidity index,tumor size,treatment type,and facility type,treatment at intermediate-volume(HR 1.238,95%CI 1.155-1.329,p<0.001)and low-volume facilities(HR=1.413,95%CI 1.306-1.528,p<0.001)were independent risk factors of all-cause mortality,while facility type was not independently associated with overall survival.Conclusion:Management and outcomes of PA appear to be dependent on the treatment facility volume,with high-volume facilities,but not necessarily facility type,being associated with improved outcomes overall.
