Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1234-1242
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1234
Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments
Po-Kuei Hsu, Hui-Shan Chen, Bing-Yen Wang, Shiao-Chi Wu, Chao-Yu Liu, Chih-Hsun Shih, Chia-Chuan Liu
Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
Po-Kuei Hsu, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Hui-Shan Chen, Shiao-Chi Wu, Institute of Health and Welfare Policy, National Yang-Ming University, Taipei 112, Taiwan
Bing-Yen Wang, Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Taichung 500, Taiwan
Chao-Yu Liu, Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
Chih-Hsun Shih, Chia-Chuan Liu, Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei 112, Taiwan
Author contributions: Hsu PK, Chen HS and Wang BY contributed equally to this study; Liu CC and Hsu PK designed the research; Chen HS performed the statistical analyses; Wu SC, Liu CC, Shih CH, Wang BY and Liu CY analyzed the data; Hsu PK wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chia-Chuan Liu, MD, Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, 125, Lide Rd., Beitou Dist., Taipei 112, Taiwan. gcliu@kfsyscc.org
Telephone: +886-2-66030716 Fax: +886-2-28732131
Received: May 7, 2014
Peer-review started: May 7, 2014
First decision: June 10, 2014
Revised: July 3, 2014
Accepted: August 13, 2014
Article in press: August 28, 2014
Published online: January 28, 2015
Abstract

AIM: To study the “hospital type-outcome” and “volume-outcome” relationships in patients with esophageal cancer who receive non-surgical treatments.

METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, > 56 cases) or an upper quartile (> 75%) volume of 377 cases (annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival.

RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, > 94 vs≤ 94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ≤ 94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94 (31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume > 94 vs≤ 94) were independent prognostic factors.

CONCLUSION: Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.

Keywords: Cancer registry, Esophageal cancer, Hospital volume, Hospital type, Survival

Core tip: The hospital type-outcome and volume-outcome relationships in patients with esophageal cancer who receive surgical resection are well established. However, little is known concerning the hospital type- and volume-outcome relationships in patients without surgical resection. Our population-based study, including 3955 non-surgically treated patients, showed that the medical center is not a significant prognostic factor. Moreover, the high-volume hospitals were not associated with better survival rates compared with the low-volume hospitals.