Introduction: Prior studies have demonstrated superior survival outcomes in patients with various cancer types treated at academic centers (ACs) and high volume facilities (HVFs). However, no "real-world population" study has been conducted to investigate the association between facility type and outcomes in low-grade glioma (LGG) patients.

Methods: A retrospective cohort study was conducted in 3346 LGG patients (Oligodendroglioma: 43.5%, astrocytoma: 40.6%, and mixed oligoastrocytoma: 15.9%) between 2004 and 2014 from the National Cancer Database (NCDB). Patients were categorized into four groups crossed by facility type (non-AC vs. AC) and facility volume (cut-off: median, LVF vs. HVF). Primary outcome was overall survival (OS). Care transition, treatment strategies including tumor resection, biopsy, radiation therapy (RT), chemotherapy, and short-term outcomes (inpatient stay and receipt of treatment) were set as secondary endpoints. Kaplan-Meier and Cox proportional hazards regression were applied for survival analysis. Multivariate logistic regression was performed to compare differences in transition, treatment and related outcomes.

Results: Patients treated at AC & HVF had the best survival, compared to those at AC & LVF or non-AC & LVF (median OS: 140.4, 118.4, and 103.3 months, respectively, log-rank test: P<0.001). In multivariate analysis, significant survival benefits were observed in AC & HVF (HR: 0.80, 95% CI: 0.68-0.94, P=0.006). Multivariate logistic regression revealed that the probability of prolonged length of inpatient stay (LOS) was decreased by 32% (OR: 0.68, 95% CI: 0.54-0.86, P=0.001) at AC & HVF. Patients at AC & HVF were more likely to undergo tumor resection rather than biopsy, to receive chemotherapy, and less likely to get transferred to other facilities.

Conclusions: This study provides evidence of superior outcomes when LGG patients are treated at academic facilities and high-volume centers. The benefit might be attributable to sub-specialization leading to more aggressive resections, shorter LOS, and increased likelihood of receiving adjuvant therapies.

Patient Care: This study provides evidence of superior outcomes when LGG patients are treated at academic facilities and high-volume centers, which might be attributed to premium healthcare resources at academic centers or high-volume facilities.

Learning Objectives: 1. To examine and estimate the survival disparity between facility type/volume for LGG patients. 2. To confirm the survival benefit for the LGG patients treated at AC or HVF by adjusting the potential confounders. 3. To investigate the differences in care transition, treatment modality, and length of inpatient by facility type/volume for LGG patients.

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