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Association of Facility Case Volume and Patient Travel Distance With Survival in Laryngeal Squamous Cell Carcinoma
Eric Y Du1, Derek S Mann1, Robert P Zitsch1
1Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA.
Background:
Treatment of laryngeal squamous cell carcinoma (SCC) requires specialized expertise. While high-volume facilities demonstrate superior outcomes, the relationship between facility volume and travel distance on survival remains poorly understood.
Methods:
Retrospective cohort study using the National Cancer Database (2004-2022) of adults with laryngeal SCC receiving definitive treatment. Risk-adjusted restricted cubic splines characterized non-linear survival relationships, guiding development of multivariable Cox-proportional hazards regression models.
Results:
Among 106 700 patients, an inflection point was identified at 10 cases/year. Below this threshold, volume had no effect (HR 1.00 [95% CI: 0.97-1.03]); above it, each doubling was associated with an 11% mortality reduction (HR 0.89 [0.84-0.94]). Travel distance showed a paradoxical protective effect (HR 0.97 [0.96-0.99]), but only in advanced-stage disease (HR 0.96 [0.94-0.97]), with no effect in early-stage disease.
Conclusions:
A 10-case/year threshold exists for laryngeal SCC care. Early-stage disease can be treated at facilities meeting this, while advanced-stage disease may warrant referral to higher-volume centers.
