Long-term effect of hospital volume on the postoperative prognosis of 158,618 patients with esophageal squamous cell carcinoma in China

Frontiers in Oncology

Oncology

Jian-Wei Ku¹  Qi-De Bao²  Zhi-Wei Chang³  Yan-Ru Qin³  Hai-Jun Yang⁴  Xue-Min Li⁵  Jing-Li Ren⁶  Ling Yuan⁷  Fu-You Zhou⁸  Xian-Zeng Wang⁹  Li-Guo Zhang^1,10  Wen-Li Han^1,11  Ling-Ling Lei^1,11  Kan Zhong^1,11  Miao-Miao Yang^1,11  Bei Li^1,11  Meng-Xia Wei^1,11  Xin Song^1,11  Rui-Hua Xu^1,11  Xue-Ke Zhao^1,11  Jing-Feng Hu^1,11  Lin Sun^1,11  Zong-Min Fan^1,11  Xue-Na Han^1,11  Pan-Pan Wang^1,11  Ran Wang^1,11  Li-Dong Wang^1,11 

[1] Department of Gastroenterology, The Second Affiliated Hospital of Nanyang Medical College, Nanyang, Henan, China;Department of Oncology, Anyang District Hospital, Anyang, Henan, China;Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China;Department of Pathology, Anyang Tumor Hospital, Anyang, Henan, China;Department of Pathology, Hebei Provincial Cixian People’s Hospital, Cixian, Hebei, China;Department of Pathology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China;Department of Radiotherapy, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China;Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, Henan, China;Department of Thoracic Surgery, Linzhou People’s Hospital, Linzhou, Henan, China;Department of Thoracic Surgery, Xinxiang Central Hospital, Xinxiang, Henan, China;State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China;

关键词: hospital volume;    esophageal squamous cell carcinoma;    esophagectomy;    postoperative survival;    retrospective analysis;   

DOI  :  10.3389/fonc.2022.1056086

 received in 2022-09-28, accepted in 2022-12-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe impact of hospital volume on the long-term survival of esophageal squamous cell carcinoma (ESCC) has not been well assessed in China, especially for stage I–III stage ESCC. We performed a large sample size study to assess the relationships between hospital volume and the effectiveness of ESCC treatment and the hospital volume value at the lowest risk of all-cause mortality after esophagectomy in China.AimTo investigate the prognostic value of hospital volume for assessing postoperative long-term survival of ESCC patients in China.MethodsThe date of 158,618 patients with ESCC were collected from a database (1973–2020) established by the State Key Laboratory for Esophageal Cancer Prevention and Treatment, the database includes 500,000 patients with detailed clinical information of pathological diagnosis and staging, treatment approaches and survival follow-up for esophageal and gastric cardia cancers. Intergroup comparisons of patient and treatment characteristics were conducted with the X2 test and analysis of variance. The Kaplan-Meier method with the log-rank test was used to draw the survival curves for the variables tested. A Multivariate Cox proportional hazards regression model was used to analyze the independent prognostic factors for overall survival. The relationship between hospital volume and all-cause mortality was assessed using restricted cubic splines from Cox proportional hazards models. The primary outcome was all-cause mortality.ResultsIn both 1973-1996 and 1997-2020, patients with stage I-III stage ESCC who underwent surgery in high volume hospitals had better survival than those who underwent surgery in low volume hospitals (both P<0.05). And high volume hospital was an independent factor for better prognosis in ESCC patients. The relationship between hospital volume and the risk of all-cause mortality was half-U-shaped, but overall, hospital volume was a protective factor for esophageal cancer patients after surgery (HR<1). The concentration of hospital volume associated with the lowest risk of all-cause mortality was 1027 cases/year in the overall enrolled patients.ConclusionHospital volume can be used as an indicator to predict the postoperative survival of ESCC patients. Our results suggest that the centralized management of esophageal cancer surgery is meaningful to improve the survival of ESCC patients in China, but the hospital volume should preferably not be higher than 1027 cases/year.Core tipHospital volume is considered to be a prognostic factor for many complex diseases. However, the impact of hospital volume on long-term survival after esophagectomy has not been well evaluated in China. Based on a large sample size of 158,618 ESCC patients in China spanning 47 years (1973-2020), We found that hospital volume can be used as a predictor of postoperative survival in patients with ESCC, and identified hospital volume thresholds with the lowest risk of death from all causes. This may provide an important basis for patients to choose hospitals and have a significant impact on the centralized management of hospital surgery.

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