Volume-outcome associations in head and neck cancer treatment: A systematic review and meta-analysis

Abstract

Background. Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high- and low-volume centers have demonstrated mixed results. Methods. We conducted a systematic review using MEDLINE and EMBASE including all studies examining a volume-outcome relationship in the treatment of patients with head and neck cancer with metaanalysis for long-term survival results. Results. Seventeen studies were identified. Meta-analysis was performed for studies that assessed long-term survival. High-volume hospitals (5 studies; hazard ratio [HR], 0.886; 95% confidence interval [CI], 0.820-0.956) and high-volume surgeons (2 studies; HR, 0.767; 95% CI, 0.641-0.919) have better overall survival than low-volume hospitals and surgeons, respectively. Conclusion. Volume-outcome associations exist for head and neck oncologic procedures, although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care, which may explain this relationship.