Association between hospital volume and survival in patients with locally advanced breast cancer

Prior studies have shown favorable post-surgical outcomes for patients with breast cancer treated at higher-volume hospitals. However, the impact of hospital volume on the management and outcomes for patients with locally advanced breast cancer (LABC) is unknown.

This retrospective study included 42,980 patients from the National Cancer Database (NCDB) with LABC treated between 2010 and 2017 at 1306 cancer-accredited centers. Centers were categorized as high-, medium-, and low-volume centers based on the number of patients with LABC seen annually. We assessed the association between hospital volume, receipt of trimodality therapy (TMT), and overall survival (OS), adjusting for demographic, clinical, and treatment variables.

High-volume centers treated a median of 18.6 patients (range 15.4, 90.7) per year compared to 8.0 and 2.9 patients at medium- and low-volume centers, respectively. High-volume centers included more academic/research centers; served younger, higher-income, and racially diverse patients; and achieved higher rates of timely (within 60 days of diagnosis) neoadjuvant systemic therapy (NST) initiation and pathologic complete response (pCR) compared to low-volume centers (all P < .001). Treatment at high-volume centers (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82, 0.97; P < .001) and receipt of recommended TMT (HR, 0.52; 95% CI 0.50, 0.54; P < .001) were independently associated with improved 5-year OS.

Higher hospital volume was associated with improved survival outcomes in patients with LABC, influenced by greater adherence to guideline-concordant care. Efforts should focus on enhancing the capacity of low-volume centers to replicate high-volume care standards, addressing access and outcomes for vulnerable populations.