2806 - Survival Outcomes in Patients Receiving Radiation for Locally Advanced Cervical Cancer Based on Facility Type
Presenter(s)
R. Marchant1, X. Hu2, K. A. Ward3, N. Ridge4, N. Ali4, A. McCook-Veal5, J. Switchenko6, P. Santos4, and J. S. Remick4; 1Wellstar Kennestone Regional Medical Center, Marietta, GA, 2Department of Radiation Oncology at Emory University School of Medicine, Atlanta, GA, 3Department of Radiation Oncology, Emory University, Atlanta, GA, 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 5Winship Cancer Institute of Emory University, Atlanta, GA, 6Department of Biostatistics & Bioinformatics, Rollins School of Public Health, and Winship Cancer Institute of Emory University, Atlanta, GA
Purpose/Objective(s): Prior studies suggest patients with locally advanced cervical cancer (LACC) treated at academic cancer centers have improved clinical outcomes compared to those treated at community cancer centers; however, it is unclear if this applies across all stages and diagnosis years. The purpose of this study is to compare survival among patients with LACC treated with radiation therapy (RT) at academic centers (AC) versus community centers (CC) stratified by stage and year of diagnosis.
Materials/Methods: This retrospective cohort study included patients from the US National Cancer Center Database diagnosed with LACC treated with RT from 2004-2018 at either AC or CC. Inclusions were age >18, AJCC stage IB2-IVA, and receipt of pelvis directed RT. Exclusions were primary tumor surgery, metastatic disease, RT duration of <20 />100 days, or treatment at an Integrated Network Cancer Program due to their broad inclusion criteria. Primary endpoint was overall survival (OS) estimated by Kaplan-Meier method with subset analysis performed by patient stage and year of diagnosis. Multivariate cox regression analysis (MVA) was performed to assess factors associated with survival. P-value < 0.05 was considered statistically significant.
Results: In total, 9,702 patients with LACC treated at AC (n=5547) or CC (n=4155) were identified. Two-year OS and median OS for patients treated at AC were 78.7% (95% CI: 77.6-79.8) and 148.4 months (95% CI: 133.1-162.7), respectively, compared to 76.1% (95% CI: 74.8-77.4) and 124.9 months (95% CI: 115.6-137.6) for patients treated at CC (p=0.003). When stratified by stage, a statistically significant difference was observed for Stage II disease treated at AC (median OS not reached, 95% CI: 184.8-NR) compared to those treated at CC (166.8, 95% CI: 143.4-NR) (p=0.0045) but not for Stage I, III or IV. Patients diagnosed between 2004-2009 treated at AC versus CC had a one-year OS of 88.1% (95% CI: 86.4-89.6) and 84.4% (95% CI: 82.3-86.3) (p=0.021), respectively, with progressively decreased difference in OS from 2010-2013 (p=0.08), 2014-2016 (p=0.38) and 2017-2018 (p=0.79). In MVA, older age (HR 1.02, CI 1.01-1.02; p<0.001), Black race (HR 1.09, CI 1.00-1.18; p<0.001), rural setting (HR 1.29, CI 1.05-1.59; p=0.015), government (Medicare/Medicaid/other) insurance (HR 1.36, CI 1.26-1.47; p<.001), diagnosis year 2004-2009 (HR 1.55, CI: 1.37-1.76; <.001), 2010-2013 (HR 1.25, CI 1.10-1.42; <0.001, vs. 2014-2016) and more advanced stage (Stage IV: HR 3.77, CI 3.13-4.53, p<0.001; Stage III: HR 2.42, CI 2.07-2.83, p<0.001; Stage II HR 1.27, CI 1.08-1.50, p= 0.004 ) were associated with worse OS, however, facility type was not.
Conclusion: Better OS was observed at AC compared to CC among patients diagnosed in earlier years and among those with Stage II disease; however, it appears such gap has closed in more recent years and after adjusting for sociodemographic characteristics.