The association of hospital volume status with treatment and survival outcomes of intracranial meningioma patients: a multivariable analysis of the National Cancer Database

Abstract

Purpose: This study investigates the influence of treatment center volume on survival outcomes and treatment strategies for patients with intracranial meningioma.

Methods: This is a retrospective cohort study of patients from the National Cancer Database treated for intracranial meningioma from 2004 to 2019. High-volume facility was defined as performing > 45 meningioma procedures/year (top 15%). Logistic regression was used for categorical comparisons. All patients were assessed whether facility volume status was associated with survival outcomes using log-rank tests and a final adjusted Cox proportional hazards model.

Results: 181,401 patients were included; 28,325 (15.6%) were treated at high-volume facilities, and 153,076 (84.4%) at low-volume facilities. In adjusted analyses, patients were more likely to be treated at high-volume facilities if they had private insurance status (OR = 1.25, 95% CI 1.21-1.29, p < 0.01) and higher tumor volume (OR = 1.11, 95% CI 1.07-1.14, p < 0.01). Patients treated at high-volume facilities were more likely to receive surgery (OR = 1.43, 95% CI 1.38-1.47, p < 0.01), radiotherapy (OR = 1.5, 95% CI 1.43-1.57, p < 0.01), stereotactic radiosurgery (OR = 1.56, 95% CI 1.48-1.65, p < 0.01), but were less likely to require readmission at 30 days (OR = 0.86, 95% CI 0.79-0.94, p = 0.01). On multivariable analysis, treatment at a high-volume facility was a positive predictor of survival (HR = 0.62, 95% CI 0.55 - 0.70, p < 0.01).

Conclusions: Most meningiomas are treated at low-volume facilities. Patients treated at high-volume facilities are more likely to receive surgery, radiotherapy, and stereotactic radiosurgery are also more likely to have improved survival when compared to patients treated at low-volume facilities. These findings collectively indicate that patients with lower socioeconomic support may experience worse survival outcomes because they struggle to access care at high-volume facilities. This information should be taken into account when shaping future healthcare policies and designing upcoming multicenter studies on meningioma.

Keywords: Disparities; Meningioma; National Cancer Database; Neuro-oncology; Skull base; Social determinants of health.