F-095DOES HOSPITAL VOLUME AFFECT LONG-TERM SURVIVAL IN OESOPHAGEAL CANCER PATIENTS? A POPULATION-BASED STUDY IN TAIWAN

Objectives: Evidence has shown that high volume hospital is associated with improved postoperative mortality rate. However, controversy exists regarding the impact of hospital volume on long-term survival. We aim to evaluate whether hospital volume affects long-term patient survival in oesophageal cancer patients. Methods: A total of 6106 patients diagnosed as oesophageal cancer between 2008 and 2011 were identified from a national population-based cancer registration database (Health Promotion Administration, Ministry of Health and Welfare). Analyses were stratified by treatment modality (Group 1: primary oesophagectomy; Group 2: neoadjuvant chemoradiation followed by oesophagectomy; Group 3: definitive chemoradiation). Hospital volume thresholds were determined by dividing patients into two approximately equal-sized groups based on the median surgical volume (21 cases per year) in group 1 and 2 or median total case volume (56 cases per year) in group 3. Cox regression analyses were used to study the volume-outcome relationship. Results: There were 1301, 850, and 3955 patients in group 1, 2, and 3, respectively. In group 1, the 1- and 3- year overall survival rates at high volume hospital were significantly higher (78.1% and 50.0%) compared to those at low volume hospital (67.9% and 38.8%, P < 0.001). Hospital volume (HR = 1.37, 95% CI 1.09-1.73, P = 0.007), cT, pT, pN stages and margin status were significant prognostic factors in the multivariate analysis. On the contrary, no significant association between hospital volume and survival was noted in group 2 and 3. The TNM stages and margin status (in group 2) were significant prognostic factors in group 2 and 3. Conclusions: The significant relationship between hospital volume and long-term survival in patients receiving primary resection supports the idea “practice-makes-perfect”, i.e. better surgical techniques lead to better outcome. For patients receiving neoadjuvant chemoradiation first or definitive chemoradiation, tumour biology has a greater effect on the survival than hospital volume. Disclosure: No significant relationships.