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The Effect of Hospital Case Volume on Clinical Outcomes in Patients with Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Analysis (KROG-1106)

 Boram Ha  ;  Kwan Ho Cho  ;  Sung Ho Moon  ;  Chang-Geol Lee  ;  Ki Chang Keum  ;  Yeon-Sil Kim  ;  Hong-Gyun Wu  ;  Jin Ho Kim  ;  Yong Chan Ahn  ;  Dongryul Oh  ;  Jae Myoung Noh  ;  Jong Hoon Lee  ;  Sung Hwan Kim  ;  Won Taek Kim  ;  Young-Taek Oh  ;  Min Kyu Kang  ;  Jin Hee Kim  ;  Ji-Yoon Kim  ;  Moon-June Cho  ;  Chul Seoung Kay  ;  Jin Hwa Choi 
 CANCER RESEARCH AND TREATMENT, Vol.51(1) : 12-23, 2019 
Journal Title
Issue Date
Hospital ; Intensity-modulated radiotherapy ; Low- or high-volume ; Nasopharyngeal neoplasms ; Three-dimensional conformal radiotherapy ; Treatment outcome
PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC).

Materials and Methods: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS).

RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170).

CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
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