Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments

AIM: To study the "hospital type-outcome" and "volumeoutcome" 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 c T, c N, c M 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 c T, c N, and c M stages and hospital volume(annual volume > 94 vs ≤94) were independent prognostic factors.CONCLUSION: Whether the treatment occurs in medicalcenters is not a significant prognostic factor. Highvolume hospitals were not associated with better survival rates compared with low-volume hospitals.