Journal of Neuro-Oncology

, Volume 135, Issue 3, pp 529–534 | Cite as

Association between hospital volume and receipt of treatment and survival in patients with glioblastoma

  • Matthew KoshyEmail author
  • David J. Sher
  • Michael Spiotto
  • Zain Husain
  • Herb Engelhard
  • Konstantin Slavin
  • Martin K. Nicholas
  • Ralph R. Weichselbaum
  • Chad Rusthoven
Clinical Study


The relation between hospital volume and outcomes for patients with glioblastoma is unknown. We undertook this study to determine the effect of hospital volume on treatment received and its effect on survival in patients with glioblastoma. We included patients from the National Cancer Database diagnosed with a glioblastoma from 2006 to 2013. Hospital volume was calculated by examining the treating facilities average number of cases per year and grouping them into tertiles: (low < 9.25, medium 9.26–23.88, and high ≥ 23.39). Treatment was defined as receiving any type of therapeutic surgery, radiation or chemotherapy. Using regression models we examined the relation between hospital volume to treatment received and survival with adjustment for clinical, socioeconomic and institutional factors. The study included 68,726 patients of which 91.8% received treatment. Among patients diagnosed at low volume facilities, 90.1% received treatment versus 94.2% in high volume facilities (p < 0.0001). Compared to low volume centers, the odds ratio of receiving any treatment was 1.01 (CI 95% CI: 0.95–1.09) and 1.43 (95% CI: 1.31–1.55) for medium volume and high volume facilities, respectively. On multivariate analysis for survival among those who received treatment, the hazard of mortality was decreased at high volume (HR 0.92, 95% CI 0.89–0.94) facilities compared to low volume facilities. Patients diagnosed with glioblastoma at a high volume facility (≥23.39 cases per year) have an increased likelihood of receiving treatment. Furthermore, glioblastoma patients may significantly improve their survival by choosing to receive care at a high-volume hospital.


Glioblastoma Hospital volume Brain tumors 




Compliance with ethical standards

Ethical approval

This article contains deidentified patient data collected from a nationwide registry and therefore does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466. doi:  10.1016/S1470-2045(09)70025-7 CrossRefPubMedGoogle Scholar
  2. 2.
    Linz U (2009) Commentary on effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466. doi:  10.1002/cncr.24950 CrossRefGoogle Scholar
  3. 3.
    Buckner JC (2003) Factors influencing survival in high-grade gliomas. Semin Oncol 30:10–14CrossRefPubMedGoogle Scholar
  4. 4.
    Lamborn KR, Chang SM, Prados MD (2004) Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 6:227–235. doi:  10.1215/S1152851703000620 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E et al (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198. doi:  10.3171/jns.2001.95.2.0190 CrossRefPubMedGoogle Scholar
  6. 6.
    Jeremic B, Milicic B, Grujicic D, Dagovic A, Aleksandrovic J (2003) Multivariate analysis of clinical prognostic factors in patients with glioblastoma multiforme treated with a combined modality approach. J Cancer Res Clin Oncol 129:477–484. doi:  10.1007/s00432-003-0471-5 CrossRefPubMedGoogle Scholar
  7. 7.
    Lutterbach J, Sauerbrei W, Guttenberger R (2003) Multivariate analysis of prognostic factors in patients with glioblastoma. Strahlenther Onkol 179:8–15. doi:  10.1007/s00066-003-1004-5 CrossRefPubMedGoogle Scholar
  8. 8.
    Zarnett OJ, Sahgal A, Gosio J, Perry J, Berger MS, Chang S, Das S (2015) Treatment of elderly patients with glioblastoma: a systematic evidence-based analysis. JAMA Neurol 72:589–596. doi:  10.1001/jamaneurol.2014.3739 CrossRefPubMedGoogle Scholar
  9. 9.
    Barker FG, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol 7:49–63. doi:  10.1215/S1152851704000146 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Meyer FB, Bates LM, Goerss SJ, Friedman JA, Windschitl WL, Duffy JR, Perkins WJ, O’Neill BP (2001) Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clin Proc 76:677–687CrossRefPubMedGoogle Scholar
  11. 11.
    Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W et al (2017) Short-course radiation plus Temozolomide in elderly patients with glioblastoma. N Engl J Med 376:1027–1037. doi:  10.1056/NEJMoa1611977 CrossRefPubMedGoogle Scholar
  12. 12.
    Luchtenborg M, Riaz SP, Coupland VH, Lim E, Jakobsen E, Krasnik M, Page R, Lind MJ, Peake MD, Moller H (2013) High procedure volume is strongly associated with improved survival after lung cancer surgery. J Clin Oncol 31:3141–3146. doi: 10.1200/JCO.2013.49.0219 CrossRefPubMedGoogle Scholar
  13. 13.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280:1747–1751.CrossRefPubMedGoogle Scholar
  14. 14.
    Wuthrick EJ, Zhang Q, Machtay M, Rosenthal DI, Nguyen-Tan PF, Fortin A, Silverman CL, Raben A, Kim HE, Horwitz EM et al (2015) Institutional clinical trial accrual volume and survival of patients with head and neck cancer. J Clin Oncol 33:156–164. doi: 10.1200/JCO.2014.56.5218 CrossRefPubMedGoogle Scholar
  15. 15.
    Chen YW, Mahal BA, Muralidhar V, Nezolosky M, Beard CJ, Den RB, Feng FY, Hoffman KE, Martin NE, Orio PF et al (2016) Association between treatment at a high-volume facility and improved survival for radiation-treated men with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 94:683–690 doi:  10.1016/j.ijrobp.2015.12.008 CrossRefPubMedGoogle Scholar
  16. 16.
    National Cancer Database (2012) update Accessed 20 January , 2015
  17. 17.
    Bilimoria KY, Stewart AK, Winchester DP, Ko CY (2008) The national cancer data base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15:683–690. doi:  10.1245/s10434-007-9747-3 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Yabroff KR, Harlan L, Zeruto C, Abrams J, Mann B (2012) Patterns of care and survival for patients with glioblastoma multiforme diagnosed during 2006. Neuro Oncol 14:351–359. doi:  10.1093/neuonc/nor218 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. doi: 10.1056/NEJMoa043330 CrossRefPubMedGoogle Scholar
  20. 20.
    Robin AM, Walbert T, Mikkelsen T, Kalkanis SN, Rock J, Lee I, Rosenblum ML (2014) Through the patient’s eyes: the value of a comprehensive brain tumor center. J Neurooncol 119:465–472. doi: 10.1007/s11060-014-1494-2 CrossRefPubMedGoogle Scholar
  21. 21.
    Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF (2002) The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 131:6–15CrossRefPubMedGoogle Scholar
  22. 22.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137. doi: 10.1056/NEJMsa012337 CrossRefPubMedGoogle Scholar
  23. 23.
    Boero IJ, Paravati AJ, Xu B, Cohen EE, Mell LK, Le QT, Murphy JD (2016) Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy. J Clin Oncol 34:684–690. doi: 10.1200/JCO.2015.63.9898 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chen AY, Pavluck A, Halpern M, Ward E (2009) Impact of treating facilities’ volume on survival for early-stage laryngeal cancer. Head Neck 31:1137–1143. doi:  10.1002/hed.21072 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Matthew Koshy
    • 1
    • 2
    Email author
  • David J. Sher
    • 3
  • Michael Spiotto
    • 1
    • 2
  • Zain Husain
    • 4
  • Herb Engelhard
    • 5
  • Konstantin Slavin
    • 5
  • Martin K. Nicholas
    • 6
  • Ralph R. Weichselbaum
    • 1
    • 2
  • Chad Rusthoven
    • 7
  1. 1.Department of Radiation OncologyUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Radiation and Cellular OncologyThe University of ChicagoChicagoUSA
  3. 3.Department of Radiation OncologyUT Southwestern Medical CenterDallasUSA
  4. 4.Department of Radiation OncologyYale UniversityNew HavenUSA
  5. 5.Department of NeurosurgeryUniversity of Illinois at ChicagoChicagoUSA
  6. 6.Department of NeurologyUniversity of Illinois at ChicagoChicagoUSA
  7. 7.Department of Radiation OncologyUniversity of ColoradoAuroraUSA

Personalised recommendations