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dc.contributor.authorvon Itzstein, Mitchell S
dc.contributor.authorLu, Rong
dc.contributor.authorKernstine, Kemp H
dc.contributor.authorHalm, Ethan A
dc.contributor.authorWang, Shidan
dc.contributor.authorXie, Yang
dc.contributor.authorGerber, David E
dc.date.accessioned2021-01-18T22:11:01Z
dc.date.available2021-01-18T22:11:01Z
dc.date.issued2020
dc.identifier.issn2045-7634en_US
dc.identifier.doi10.1002/cam4.3055en_US
dc.identifier.urihttp://hdl.handle.net/10072/401237
dc.description.abstractBackground: Clinical outcomes for resected early-stage non-small cell lung cancer (NSCLC) are superior at high-volume facilities, but reasons for these differences remain unclear. Understanding these differences and optimizing outcomes across institutions are critical to the management of the increasing incidence of these cases. We evaluated the extent to which surgical best practices account for resected early-stage NSCLC outcome differences between facilities according to case volume. Methods: We performed a retrospective cohort study for clinical stage 1 or 2 NSCLC undergoing surgical resection from 2004 to 2013 using the National Cancer Database (NCDB). Surgical best practices (negative surgical margins, lobar or greater resection, lymph node (LN) dissection, and examination of > 10 LNs) were compared between the highest and lowest quartile volumes. Results: A total of 150,179 patients were included in the cohort (89% white, 53% female, median age 68 years). In a multivariate model, superior overall survival (OS) was observed at highest volume centers compared to lowest volume centers (hazard ratio (HR) = 0.89; 95% CI, 0.82-0.96; P =.002). After matching for surgical best practices, there was no significant OS difference (HR = 0.95; 95% CI, 0.87-1.05; P =.32). Propensity score-adjusted HR estimates indicated that surgical best practices accounted for 54% of the numerical OS difference between low-volume and high-volume centers. Each surgical best practice was independently associated with improved OS (all P ≤.001). Conclusion: Quantifiable and potentially modifiable surgical best practices largely account for resected early-stage NSCLC outcome differences observed between low- and high-volume centers. Adherence to these guidelines may reduce and potentially eliminate these differences.en_US
dc.description.peerreviewedYesen_US
dc.languageEnglishen_US
dc.publisherWileyen_US
dc.relation.ispartofpagefrom4137en_US
dc.relation.ispartofpageto4147en_US
dc.relation.ispartofissue12en_US
dc.relation.ispartofjournalCancer Medicineen_US
dc.relation.ispartofvolume9en_US
dc.subject.fieldofresearchBiochemistry and Cell Biologyen_US
dc.subject.fieldofresearchOncology and Carcinogenesisen_US
dc.subject.fieldofresearchcode0601en_US
dc.subject.fieldofresearchcode1112en_US
dc.subject.keywordsScience & Technologyen_US
dc.subject.keywordsLife Sciences & Biomedicineen_US
dc.subject.keywordsguidelinesen_US
dc.subject.keywordslobectomyen_US
dc.titleClosing the gap: Contribution of surgical best practices to outcome differences between high- and low-volume centers for lung cancer resectionen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Articlesen_US
dcterms.bibliographicCitationvon Itzstein, MS; Lu, R; Kernstine, KH; Halm, EA; Wang, S; Xie, Y; Gerber, DE, Closing the gap: Contribution of surgical best practices to outcome differences between high- and low-volume centers for lung cancer resection, Cancer Medicine, 2020, 9 (12), pp. 4137-4147en_US
dcterms.dateAccepted2020-03-30
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/en_US
dc.date.updated2021-01-18T22:01:30Z
dc.description.versionVersion of Record (VoR)en_US
gro.rights.copyright© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.en_US
gro.hasfulltextFull Text
gro.griffith.authorVon Itzstein, Mitchell S.


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