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We sought to compare the outcomes of teaching and community hospitals on long-term outcomes for patients with rectal cancer. All rectal adenocarcinomas treated in Florida from 1994 to 2000 were examined. Overall, 5,925 operative cases were identified. Teaching hospitals treated 12.5% of patients with a larger proportion of regionally advanced, metastatic disease, as well as high-grade tumors. Five- and 10-year overall survival rates at teaching hospitals were 64.8 and 53.9%, compared to 59.1 and 50.5% at community hospitals (P=0.002). The greatest impact on survival was observed for the highest stage tumors: patients with metastatic rectal adenocarcinoma experienced 5- and 10-year survival rates of 30.5 and 26.6% at teaching hospitals compared to 19.6 and 17.4% at community hospitals (P=0.009). Multimodality therapy was most frequently administered in teaching hospitals as was low anterior resection. On multivariate analysis, treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio=0.834, P=0.005). Rectal cancer patients treated at teaching hospitals have significantly better survival than those treated at community-based hospitals. Patients with high-grade tumors or advanced disease should be provided the opportunity to be treated at a teaching hospital. [ABSTRACT FROM AUTHOR]

Purpose: To determine prognostic significance of hospital surgical volume and Children's Oncology Group (COG) membership on neuroblastoma (NBL) and Wilms tumor (WT) survival., Methods: The Florida Cancer Data System was queried from 1981 to 2004., Results: Of 869 NBL patients, 463 were treated at COG/HVC, 246 at COG/LVC, and 160 at non-COG/LVC. COG hospitals treated a larger proportion of patients <1 year of age (P = 0.002) and relatively more patients with adrenal and mediastinal tumors (P = 0.005). COG centers more frequently administered chemotherapy (72% vs. 51%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (70.6%, 67.7%) and COG/LVC (75.8%, 72.6%) than non-COG/LVC (59.5%, 54.4%, P < 0.05). Of 790 WT patients, 395 were treated at COG/HVC, 210 at COG/LVC, and 185 at non-COG/LVC. COG hospitals treated younger patients and lower staged tumors (P < 0.05). COG centers more frequently administered chemotherapy (88% vs. 59%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (91.3%, 89.9%) and COG/LVC (96.7%, 94.7%) than non-COG/LVC (82.4%, 81.7%, P < 0.05). Multivariate analysis demonstrated WT patients treated at non-COG hospitals, but not NBL patients, had worse survival (HR 3.107, P = 0.01)., Conclusion: Children treated at COG hospitals had higher overall use of chemotherapy. This translated into a significantly improved survival benefit for WT., (Copyright 2010 Wiley-Liss, Inc.)

Objective: To compare treatment patterns and long-term outcomes between teaching and community hospitals treating patients with infiltrating ductal carcinoma (IDC)., Methods: All IDCs from the Florida Cancer Data System from 1994 to 2000 were examined., Results: Overall, 24,834 operative cases of IDC were identified. Teaching hospitals treated 11.3% of patients with a larger proportion of stage III and IV disease (39.8% vs. 33.0%). Five- and 10-year overall survival rates at teaching hospitals were 84% and 72%, compared with 81% and 69% at high-volume community hospitals and 77% and 63% at low-volume hospitals (P < 0.001). The greatest differences on survival were observed in patients with advanced IDC. Examination of practice patterns demonstrated that multimodality therapy was most frequently administered in teaching hospitals. Breast-conserving surgery was more frequently performed at teaching hospitals (41.5% vs. 38.9% P = 0.008). On multivariate analysis, it was found that treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio = 0.763, P < 0.001). This survival benefit was greater and independent of high-volume center status (hazard ratio = 0.903, P < 0.02)., Conclusions: Patients with IDC treated at teaching hospitals have significantly better survival than those treated at high-volume centers or community hospitals, particularly in the setting of advanced disease. Poorer long-term outcomes for IDC at community hospitals seem to be, at least in part, because of decreased use of proven life-extending adjuvant therapies. These results should encourage community hospitals to institute changes in treatment approaches to invasive breast cancer to optimize patient outcomes.

Background and Objectives: To date, outcome reports for soft-tissue sarcoma (STS) have largely been limited to single or paired institutional series. To more accurately elucidate population-based outcomes and prognostic factors associated with STS, a large cancer registry was examined., Methods: STS arising in the Florida Cancer Data System were examined (1981-2004)., Results: A total of 8249 patients were identified, the calculated annual incidence of sarcoma being approximately 38 cases per million in 2003. The tumor histologies among these patients were leiomyosarcoma and gastrointestinal stromal tumor (LMS/GIST) (43.5%), malignant fibrous histiocytoma (MFH) (31.5%), liposarcoma (19.0%), and fibrosarcoma (6.0%). Tumors were situated in the extremities (30.7%), truncal or visceral locations (50.4%), retroperitoneum (11.7%), and head or neck (7.2%). Thirty-three percent of lesions were over 10 cm in greatest dimension, while 50.2% were classified as high grade. Median overall survival was 25 months. Superior survival was observed for liposarcomas and fibrosarcomas as compared to MFH and LMS/GIST (P < 0.001). Retroperitoneal and truncal sarcomas had a more ominous prognosis than did other sites (P < 0.001). Multivariate analysis of pretreatment variables demonstrated that increasing age, male gender, non-Caucasian race, advanced stage, and a truncal or retroperitoneal location were each independently associated with lower survival. Histological subtype was also an independent predictor of outcome. Surgical resection and radiation therapy were the only treatment variables shown to improve survival., Conclusions: Histological subtype, tumor site, and stage are independent prognostic factors in STS. Surgical resection and radiotherapy are unique among treatment modalities in association with a significant survival benefit.

Objective: : To define the prognostic significance of surgical center case volume on outcome for soft tissue sarcoma (STS)., Methods: : STS cases registered in the Florida Cancer Data System (FCDS) between 1981 and 2001 were analyzed. Medical facilities were ranked by STS operative volume. Facilities above the 67th percentile for volume were defined as high-volume centers (HVCs)., Results: : Of the 4205 operative cases of STS identified, 68.1% were treated at low-volume centers (LVCs) and 31.9% at HVCs. A larger proportion of high-grade tumors (53.8% vs. 44.3%) and lesions over 10 cm (40.7% vs. 28.7%) were resected at HVC (P < 0.001). The 30-day mortality was 0.7% for HVC and 1.5% for LVC (P = 0.028), and mortality rates at 90 days were 1.6% and 3.6%, respectively (P = 0.001). Median survival was 40 months at HVC and 37 months at LVC (P = 0.002). Univariate analysis demonstrated significantly improved survival at HVC for high-grade tumors (median 30 months vs. 24 months, P = 0.001), lesions over 10 cm (28 months vs. 19 months, P = 0.001) and truncal or retroperitoneal sarcomas (39 months vs. 31 months, P = 0.011). Limb amputation rate was lower (9.4% vs. 13.8%, P = 0.048) and radiation and chemotherapy were more frequently administered at HVC (OR = 1.54). On multivariate analysis, treatment at a HVC was a significant independent predictor of improved survival (OR = 1.292, P = 0.047)., Conclusions: : STS patients treated at HVC have significantly better survival and functional outcomes. Patients with either large (>10 cm), high-grade or truncal/retroperitoneal tumors should be treated exclusively at a high-volume center.

Introduction: The aim of the study was to determine outcomes for respiratory and gastrointestinal carcinoid tumors utilizing a large cancer registry., Methods: Cases of respiratory and gastrointestinal carcinoid from the Florida Cancer Data System (FCDS) from 1981 to 2001 were reviewed. Descriptive statistics, age-adjusted tumor incidence, and survival rates were determined., Results: A total of 7201 cases of malignant carcinoid were identified. Pulmonary and gastrointestinal carcinoid tumors comprised 82% of all carcinoids encountered. The mean age was 64.4 +/- 0.15 years. Stratified by location, there were 3000 (51.4%) foregut carcinoids (including those found in the respiratory tree-2325 in the lung), 2130 (36.5%) midgut carcinoids, and 712 (12.2%) hindgut carcinoids. Second, distinct malignancies were observed in 23% of cases. The total age-adjusted incidence rate has increased from 0.62 per 100,000 in 1980 to 5.17 per 100,000 in 2000. Overall median survival was 21.97 months. The median survival was 19.0 months for foregut carcinoids (excluding those arising in the respiratory tract); 33.9 months for midgut tumors; and 22.7 months for hindgut carcinoids. There was a statistically significant better survival for those with midgut tumors than for those in the other groups (P < 0.001). Age < 60 years, white race, and female sex were all associated with better survival (P < 0.01)., Conclusions: The incidence of pulmonary and gastrointestinal carcinoids has dramatically increased since 1981. Tumor location and age > or = 60 years are the strongest predictors of mortality.