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Exploring hospital volume thresholds for improved sarcoma treatment across different age categories in the United
Charbel Chidiac1, Paul Phan2, Katherine M McDermott1
1Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Introduction:
Sarcoma management is complex, requiring multidisciplinary care. Previous studies show improved outcomes at high-volume hospitals (HVHs), but optimal volume thresholds remain unclear. The aim was to identify hospital volume thresholds associated with improved survival for sarcoma patients across age groups.
Methods:
Patients with Ewing sarcoma, osteosarcoma, rhabdomyosarcoma, and nonrhabdomyosarcoma soft-tissue sarcoma were queried from the National Cancer Database (2004-2020). Patients were divided into children (0-17 years), young adults (YA) (18-39 years), and adults (≥40 years). The primary outcome was overall survival. Restricted cubic splines identified volume thresholds, which were validated using Kaplan-Meier curves and Cox regression.
Results:
Among 71,463 patients, 7829 (10.9%) were children, 12,901 (18.1%) were YA, and 50,733 (71.0%) were adults. Identified HVH thresholds were 37 cases/year for all ages, five for children and YA, and 24 for adults. Using these thresholds, 17/1289 hospitals were HVHs for all ages, 30/413 for children, 40/970 for YA, and 19/1264 for adults. Treatment at HVHs was associated with better 5-year overall survival compared to low-volume hospitals for all ages (64.8% vs. 60.0%, p < .001) and adults (63.0% vs. 56.8%, p < .001). In multivariable analysis, HVH treatment was associated with better survival across all groups: all ages (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.83-0.88), children (aHR, 0.91; 95% CI, 0.83-0.98), YA (aHR, 0.94; 95% CI, 0.88-0.99), and adults (aHR, 0.81; 95% CI, 0.78-0.85).
Conclusion:
Treatment at HVHs is associated with improved survival for sarcoma patients across all age groups. Our study defines distinct volume thresholds for children, young adults, and adults, guiding referrals and optimizing care.
