Abstract
Aims
To conduct a systematic review of the literature on the volume-outcome relationship
for the surgical treatment of breast cancer with consideration of the methodological
quality of the available evidence and to perform a meta-analysis on the studies of
considered good quality.
Methods
A systematic search was done to identify all articles examining the effects of hospital
or surgeon volume on clinical outcome of the surgical treatment of breast cancer.
Reviews, opinion articles and surveys were excluded. All articles were critically
appraised on methodological quality and risk of bias. After strict inclusion, meta-analysis
assuming a random effects model was done to estimate the effect of higher hospital
or surgeon volume on patient outcome.
Results
We found 12 studies of good methodological quality which could be included for meta-analysis.
The results showed a significant association between high volume providers and an
improved survival. The association is the most robust for surgeon volume (HR 0.80
(0.71–0.90) and RR 0.85 (0.80–0.90). In addition there is an effect of hospital volume
on the in-hospital mortality, although the mortality was very low (0.1–0.2%). Results
of meta-analysis were heterogeneous. Sensitivity analysis showed a larger effect size
for studies also adjusting for comorbidity for both studies on hospital and surgeon
volume. The data were not suggestive for publication bias.
Conclusions
The results show that survival after breast cancer surgery is significantly associated
with high volume providers.
Keywords
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Article info
Publication history
Accepted:
June 9,
2010
Footnotes
☆Study performed by the ‘Quality of cancer care’ taskforce of the Signalling Committee Cancer of the Dutch Cancer Society. (the committees full report is available on www.kwfkankerbestrijding.nl)
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
