Highlights
- •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.
Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: April 14, 2017
Accepted:
March 7,
2017
Received in revised form:
February 16,
2017
Received:
September 10,
2016
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
