OBJECTIVES The study investigated the association between hospital volume and observed survival of patients with a head and neck squamous cell carcinoma (HNSCC). METHODS Overall, 9245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry. This database was coupled with other databases providing information on diagnostic and therapeutic procedures, vital status, and comorbidities. The overall and relative survival probabilities were estimated using the Kaplan-Meier and the Ederer II methods, respectively. The relation between hospital volume and observed survival since diagnosis was then assessed using Cox proportional hazard models adjusted for potential confounders. RESULTS The care for patients with HNSCC in Belgium was dispersed over more than 99 centres with half of the centres treating four or less patients with HNSCC per year. Survival probabilities were significantly better for patients treated in higher volume centres (>20 patients/year): the median survival of patients treated in these centres was 1.1 year longer (5.1 versus 4.0 years) than in lower volume centres. This association was confirmed in analyses taking the case-mix between hospitals into account: the hazard to die of any cause decreased on average with 0.4% per increase of one additionally treated patient. Beyond 20 assigned patients per year, there was no further decrease in the hazard to die. CONCLUSIONS Statistically significant and clinically relevant improved survival probabilities were obtained in patients treated in higher volume centres (>20 patients/year) compared with their peers treated in lower volume centres. This supports the recommendation to concentrate the care for patients with HNSCC in reference centres.

中文翻译：

---

在较高的医疗中心治疗的头颈癌患者的生存率提高：比利时一项基于人群的研究。

目的本研究调查了头颈部鳞状细胞癌（HNSCC）患者的医院规模与观察到的生存之间的关系。方法总体上，在基于人群的比利时癌症登记处确定了2009年至2014年之间诊断为HNSCC的9245例患者。该数据库与其他数据库结合在一起，提供有关诊断和治疗程序，生命状况和合并症的信息。总体生存率和相对生存率分别使用Kaplan-Meier和Ederer II方法进行估算。然后使用针对潜在混杂因素调整的Cox比例风险模型评估医院的规模与自诊断以来观察到的存活率之间的关系。结果比利时对HNSCC患者的护理分散在99多个中心，其中一半的中心每年治疗4个或更少的HNSCC患者。在较高容量的中心（> 20个患者/年）中治疗的患者的生存率明显更好：与较低容量的中心相比，在这些中心中接受治疗的患者的中位生存期长1.1年（5.1对4.0年）。在考虑到医院之间的病例混合情况的分析中证实了这种关联：任何原因导致的死亡风险平均降低，每增加一名接受治疗的患者，增加0.4％。每年超过20名指定患者，死亡风险没有进一步降低。结论与较低容量中心治疗的同龄人相比，较高容量中心治疗的患者（> 20患者/年）获得了统计学上显着且临床相关的生存概率。这支持了在参考中心集中对HNSCC患者进行护理的建议。