Do Facility Demographics Impact Outcomes in NSCLC Patients Treated With Radiofrequency Ablation?
A new study sought to determine if patient and facility demographics impacted overall survival in patients with early-stage non-small cell lung cancer (NSCLC) treated with radiofrequency (RF) ablation. Results published in the Journal of Vascular and Interventional Radiology found that patients treated at high volume centers (HVCs) experienced a significant increase in overall survival (OS).
In this study, 967 cases from the National Cancer Database involving patients with stage 1a NSCLC treated with RF ablation without chemotherapy or radiotherapy from 2004 to 2014 were included. Estimated median survival was 33.1 months and follow-up was 62.5 months.
HVCs were defined as the top 95% of facilities by number of procedures performed. Of the 305 facilities, 15 were HVCs and treated >13 patients from 2004 to 2014. Of the 967 cases, 335 (34.6%) were treated at HVCs.
Kaplan-Meier method was used to estimate OS. P values less than 0.05 were considered statistically significant. Overall survival at 1 year was 85.5%, at 3 years it was 45.3%, and at 5 years it was 22.5%. Treatment at an HVC was independently associated with improved OS (hazard ratio [HR] = 0.766; P = 0.006).
Propensity score-matched cohort analysis was performed and after adjustment, 1-, 3-, and 5-year OS was 89.8%, 51.2%, and 27.7%, respectively, for patients treated at HVCs, compared to 85.2%, 41.5%, and 19.6%, respectively, for patients treated at non-HVCs (P = 0.015).
Other factors independently associated with worse OS were increasing age (HR = 1.012; P = 0.013) and higher T-classification (HR = 1.392; P < 0.001)
“In this retrospective investigation, worse OS after RF ablation for early-stage NSCLC was significantly associated with increasing age and higher T-classification, whereas improved OS was significantly associated with treatment at HVCs in both unadjusted and propensity score-adjusted cohorts,” the authors concluded. “Additionally, this knowledge may potentially be used to support regionalization of NSCLC management as a means of improving outcomes.”
Lam A, Yoshida EJ, Bui K, et al. Patient and Facility Demographics Related Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Radiofrequency Ablation: A National Cancer Database Analysis. J Vasc Interv Radiol. 2018;S1051-0443(18)31257-0. doi: 10.1016/j.jvir.2018.06.005. [Epub ahead of print].