Genitourinary Cancer

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SU_24_2243 - Effect of Radiation Treatment at a High Volume Center on Outcomes in Intermediate-Risk Prostate Cancer: An Analysis of the National Cancer Database

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Effect of Radiation Treatment at a High Volume Center on Outcomes in Intermediate-Risk Prostate Cancer: An Analysis of the National Cancer Database
G. H. Boyd1, M. M. Qureshi2, and A. E. Hirsch2; 1Boston University School of Medicine, Boston, MA, 2Department of Radiation Oncology, Boston Medical Center, Boston, MA

Purpose/Objective(s): Prior studies have noted improved overall survival in prostate cancer patients treated at centers with large radical prostatectomy case volumes. This effect has also been observed in high-risk prostate cancer patients treated with radiation at high-volume centers. The purpose of this study was to investigate the effect of radiation treatment at a high volume center on overall survival in men with intermediate-risk prostate cancer.

Materials/Methods: From 2010-2013, 90,284 patients from 1,144 facilities with radiation-treated prostate cancer were identified in the NCDB. The radiation case volume (RCV) of each hospital was calculated based on number of patients treated. High-volume centers were defined as those above the 85th percentile in patient volume (>146 patients treated). Final analysis included only patients meeting intermediate-risk prostate cancer criteria. Characteristics analyzed include age, race, distance to treatment facility, Charlson-Deyo Score (CDS), socioeconomic factors, use of androgen deprivation therapy, and number of intermediate-risk criteria met. Primary outcome was overall survival (OS). 3-year survival rates were estimated using the Kaplan-Meier method. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using multivariate (MVA) Cox regression and propensity score-matched (PSM) analysis was also performed.

Results: 40,091 patients were identified with radiation-treated intermediate-risk prostate cancer. Median (interquartile range) follow up was 36.8 months (24.4-49.6 months) with median RT dose of 77.4 Gy (70-79.2 Gy) in 40 fractions. Estimated 3-year OS was 96.3% at high RCV centers and 95.1% low RCV centers (p<0.001). On MVA, treatment at high RCV facility was associated with significantly lower mortality compared to treatment at a low RCV facility (HR=0.88, 95% CI 0.8-0.97, p=0.009). Survival benefit was confirmed on PSM analysis, with estimated 3-year OS of 96.5% at high RCV centers and 95.2% at low RCV centers (p<0.001). The survival benefit of treatment at a high RCV facility remained when high RCV facilities were defined as those above the 80th (>122 patients), 90th (>178 patients) and 95th (>245 patients) percentile in patient volume (all p<0.05).

Conclusion: Treatment at a high radiation case volume facility is associated with improved OS in patients with radiation-treated intermediate-risk prostate cancer. This survival benefit is important to consider when choosing a treatment center for radiation therapy.

Author Disclosure: G.H. Boyd: None. M.M. Qureshi: None. A.E. Hirsch: None.

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