- •A population-based study in patients treated for metastatic oesophagogastric cancer was conducted.
- •We explored the association between the annual hospital volume and survival.
- •Patients treated in high-volume surgical hospitals had a superior outcome compared to treatment in low-volume hospitals.
- •Future research should explore which specific factors of high-volume centres are associated with improved outcomes.
Palliative systemic therapy has been shown to improve survival in metastatic oesophagogastric cancer. Administration of palliative systemic therapy in metastatic oesophagogastric cancer varies between hospitals. We aimed to explore the association between the annual hospital volume of oesophagogastric cancer patients and survival.
Patients diagnosed in the Netherlands between 2005 and 2013 with metastatic oesophagogastric cancer were identified in the Netherlands Cancer Registry. Patients were attributed according to three definitions of high volume: (1) high-volume incidence centre, (2) high-volume treatment centre and (3) high-volume surgical centre. Independent predictors for administration of palliative chemotherapy were evaluated by means of multivariable logistic regression analysis, and multivariable Cox proportional hazard regression analysis was performed to assess the impact of high-volume centres on survival.
Our data set comprised 4078 patients with metastatic oesophageal cancer, and 5425 patients with metastatic gastric cancer, with a median overall survival of 20 weeks (95% confidence interval [CI] 19–21 weeks) and 16 weeks (95% CI 15–17 weeks), respectively. Patients with oesophageal cancer treated in a high-volume surgical centre (adjusted hazard ratio [HR] 0.80, 95% CI 0.70–0.91) and a high-volume treatment centre (adjusted HR 0.88, 95% CI 0.78–0.99) exhibited a decreased risk of death. For gastric cancer, patients treated in a high-volume surgical centre (adjusted HR 0.83, 95% CI 0.74–0.92) had a superior outcome.
Improved survival in patients undergoing palliative systemic therapy for oesophagogastric cancer was associated with treatment in high-volume treatment and surgical centres. Further research should be implemented to explore which specific factors of high-volume centres are associated with improved outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Gastric cancer: decreasing incidence but stable survival in The Netherlands.Acta Oncol. 2014; 53: 138-142
- Effect of hospital volume on postoperative mortality and survival after oesophageal and gastric cancer surgery in The Netherlands between 1989 and 2009.Eur J Cancer. 2012; 48: 1004-1013
- Chemotherapy for advanced gastric cancer.Cochrane Database Syst Rev. 2010; CD004064
- Optimal first-line chemotherapeutic treatment in patients with locally advanced or metastatic esophagogastric carcinoma: triplet versus doublet chemotherapy: a systematic literature review and meta-analysis.Cancer Metastasis Rev. 2015; 34: 429-441
- No improvement in median survival for patients with metastatic gastric cancer despite increased use of chemotherapy.Ann Oncol. 2013; 24: 3056-3060
- Use of chemotherapy at end of life in oncology patients.Ann Oncol. 2009; 20: 1555-1559
- “Well, I think there is great variation…”: a qualitative study of oncologists' experiences and views regarding medical criteria and other factors relevant to treatment decisions in advanced cancer.Oncologist. 2013; 18: 90-96
- Therapy preferences in melanoma treatment–willingness to pay and preference of quality versus length of life of patients, physicians and healthy controls.PLoS One. 2014; 9: e111237
- The volume-outcome relation in the surgical treatment of esophageal cancer: a systematic review and meta-analysis.Cancer. 2012; 118: 1754-1763
- Completeness of cancer registration in Limburg, The Netherlands.Int J Epidemiol. 1993; 22: 369-376
- Centralization of highly complex low-volume procedures in upper gastrointestinal surgery. A summary of systematic reviews and meta-analyses.Dig Surg. 2012; 29: 374-383
- Resected pancreatic cancer (PC): impact of adjuvant therapy (Rx) at a high volume center (HVC) on overall survival (OS).J Clin Oncol. 2016; 34 (suppl 4S; abstr 191)
- Volume matters in the systemic treatment of metastatic pancreatic cancer: a population-based study in The Netherlands.J Cancer Res Clin Oncol. 2016; 142: 1353-1360
- Understanding and reducing variation in surgical mortality.Annu Rev Med. 2009; 60: 405-415
- Interventions for dysphagia in oesophageal cancer.Cochrane Database Syst Rev. 2014; CD005048
- Radiation and chemotherapy in the management of malignant esophageal strictures.Gastrointest Endosc Clin N Am. 1998; 8: 451-463
- Antireflux stent versus conventional stent in the palliation of distal esophageal cancer. A randomized, multicenter clinical trial.Scand J Gastroenterol. 2010; 45: 208-216
- Stent placement or brachytherapy for palliation of dysphagia from esophageal cancer: a prognostic model to guide treatment selection.Gastrointest Endosc. 2005; 62: 333-340
- Conventional stents versus stents loaded with (125)iodine seeds for the treatment of unresectable oesophageal cancer: a multicentre, randomised phase 3 trial.Lancet Oncol. 2014; 15: 612-619
- The effect of socioeconomic status on staging and treatment decisions in esophageal cancer.J Clin Gastroenterol. 2012; 46: 833-839
- Variation in palliative care of esophageal cancer in clinical practice: factors associated with treatment decisions.Dis Esophagus. 2016 Feb 26; ([Epub ahead of print])https://doi.org/10.1111/dote.12478
- Indicators of poor quality end-of-life cancer care in Ontario.J Palliat Care. 2006; 22: 12-17
- Comparison of comorbidity prevalence in oesophageal and gastric carcinoma patients: a population-based study.Eur J Gastroenterol Hepatol. 2004; 16: 681-688
- Esophageal carcinoma.N Engl J Med. 2014; 371: 2499-2509
- Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer.Eur J Cancer. 1997; 33: 1216-1220
- Capecitabine in combination with either cisplatin or weekly paclitaxel as a first-line treatment for metastatic esophageal squamous cell carcinoma: a randomized phase II study.BMC Cancer. 2015; 15: 693
- Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2013; 24: vi51-56
- Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis.J Thorac Oncol. 2012; 7: 443-447
- The effect of aspirin and nonsteroidal anti-inflammatory drug use after diagnosis on survival of oesophageal cancer patients.Br J Cancer. 2016; 114: 1053-1059
- Estimates based on 177 cancer registries.Thorac Cancer. 2016; 7: 232-237
- Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer–pooled analysis from three multicenter, randomized, controlled trials using individual patient data.J Clin Oncol. 2004; 22: 2395-2403
- Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial.Lancet Oncol. 2016; 17: 309-318
- Prognosis and treatment after diagnosis of recurrent esophageal carcinoma following esophagectomy with curative intent.Ann Surg Oncol. 2015; 22: S1292-S1300
- Multidisciplinary team working in cancer: what is the evidence?.BMJ. 2010; 340: c951
- Esophageal cancer in the elderly: an analysis of the factors associated with treatment decisions and outcomes.BMC Cancer. 2010; 10: 510
Published online: April 14, 2017
Accepted: March 7, 2017
Received in revised form: February 16, 2017
Received: September 10, 2016
© 2017 Elsevier Ltd. All rights reserved.