Open Access

ARTICLE

Impact of facility type and volume on survival in patients with metastatic renal cell carcinoma

Furkan Dursun¹, Ahmed Elshabrawy¹, Hanzhang Wang¹, James Oelsen¹, Michael Liss^1,2, Dharam Kaushik^1,2, Chethan Ramamurthy^1,2, Ronald Rodriguez¹, Ahmed M. Mansour^1,2,3

1 Department of Urology, University of Texas Health Science Center at San Antonio, Texas, USA
2 UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, Texas, USA
3 Urology and Nephrology Center, Mansoura University, Egypt
Address correspondence to Dr. Ahmed M. Mansour, Urologic Oncology, UT Health San Antonio, Mail Code 7845, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA

Canadian Journal of Urology 2021, 28(5), 10806-10816.

Abstract

Introduction: To investigate the impact of facility type and volume on survival in patients with metastatic renal cell carcinoma (mRCC).
Materials and methods: We investigated the National Cancer Database for patients with mRCC. Patients were stratified according to treatment facility type (academic vs. non-academic) and facility volume (high, intermediate, and low). Kaplan-Meier survival estimates and Cox proportional hazard models were fitted to evaluate overall survival (OS) as a function of facility type, volume, and different treatment modalities.
Results: A total of 27,598 patients were identified, of which 10,938 (40%) were treated at academic centers (AC) and 16,131 (60%) at non-academic centers (non-AC). Overall, 19,904 patients (72%) were treated in high-volume hospitals (HVH). Among patients treated at AC, 94% were treated at HVHs. Patients treated at AC were more likely to receive immunotherapy, undergo cytoreductive nephrectomy (CN) and metastasectomy. The 2 and 5 year OS rates for patients treated in AC were 29.7% (CI 28.8%-30.6%) and 13% (CI 12%-14%) vs. 21.7% (CI 21%-22.4%) and 8.4% (CI 7.91%-8.99%) in the Non-AC, respectively (p < 0.001). Multivariate Cox regression analysis identified treatment at AC as an independent predictor of survival (HR 0.85, 95% CI 0.81-0.91, p < 0.001). Undergoing CN and receipt of immunotherapy was also associated with a survival benefit (HR 0.41, CI 0.40-0.43 and HR 0.63, CI 0.59-0.68 respectively, p < 0.001).
Conclusions: Treatment at ACs and HVHs was associated with a survival benefit in patients with mRCC. Patients treated at AC were more likely to receive immunotherapy, undergo CN and metastasectomy.

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