Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004–2008
- Victoria H Coupland1,
- Jesper Lagergren2,3,
- Margreet Lüchtenborg1,
- Ruth H Jack1,
- William Allum4,
- Lars Holmberg2,5,6,
- George B Hanna7,
- Neil Pearce8,
- Henrik Møller1
- 1King's College London, Thames Cancer Registry, London, UK
- 2King's College London, Division of Cancer Studies, London, UK
- 3Unit of Upper Gastrointestinal Research, Karolinska Institutet, Stockholm, Sweden
- 4Department of Surgery, The Royal Marsden NHS Foundation Trust, London, UK
- 5Uppsala Örebro Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
- 6Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- 7Department of Surgery and Cancer, Imperial College London, London, UK
- 8Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Correspondence to Victoria H Coupland, King's College London, Thames Cancer Registry, 1st Floor Capital House, 42, Weston Street, London SE1 3QD, UK;
- Accepted 9 September 2012
- Published Online First 19 October 2012
Objective This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England.
Design 62 811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30–365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients.
Results Increasing hospital volume was associated with lower mortality (ptrend=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (ptrend<0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (ptrend=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (ptrend<0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile).
Conclusions With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.