Comprehensive Cancer Centre South, Catharina Hospital, Eindhoven, The Netherlands.
Br J Surg. 2011 Jul;98(7):956-63. doi: 10.1002/bjs.7493. Epub 2011 Apr 20.
The objective was to evaluate the impact of concentration of surgery for oesophageal and gastric cardia cancer on long-term survival in the population-based Eindhoven Cancer Registry area. In contrast to most previous studies, this study aimed to evaluate both surgically and non-surgically treated patients, to avoid the confounding effect of selective referral.
This retrospective cohort study included all patients diagnosed with oesophageal or gastric cardia cancer between 1995 and 2006. Results for the period 1995-1998 were compared with those for 1999-2006, after concentration of surgery.
Between 1995 and 2006, 2212 patients were registered with the diagnosis, of whom 638 underwent resection. Before 1999, 73·4 per cent of surgically treated patients underwent a resection in a low-volume hospital (fewer than 4 resections per year) and 23·2 per cent were referred to an academic hospital. After concentration, 63·2 per cent of surgically treated patients underwent resection in one of two regional high-volume centres (15-20 resections per year) and 13·8 per cent were referred to an academic hospital. Three-year survival rates increased from 32·0 to 45·1 per cent for patients who had surgery (P = 0·004), and from 13·1 to 17·9 per cent for all included patients (P = 0·026). These improvements remained after adjustment for case mix or (neo)adjuvant treatments, and were similar for patients with squamous cell carcinoma or adenocarcinoma. However, adjustment for annual hospital volume attenuated this association for patients who had surgery.
Concentration of oesophageal and gastric cardia cancer surgery was associated with improvements in long-term, population-based overall survival for surgically as well as non-surgically treated patients, apparently mediated by an increase in volume.
本研究旨在评估以人群为基础的埃因霍温癌症登记处地区集中手术治疗食管和胃贲门癌对长期生存的影响。与大多数先前的研究不同，本研究旨在评估手术和非手术治疗的患者，以避免选择性转诊的混杂影响。
这是一项回顾性队列研究，纳入了 1995 年至 2006 年间诊断为食管或胃贲门癌的所有患者。将 1995-1998 年期间的结果与集中手术治疗后的 1999-2006 年期间的结果进行比较。
1995 年至 2006 年间，共有 2212 例患者被诊断为该疾病，其中 638 例行切除术。在 1999 年之前，73.4%的手术治疗患者在低容量医院（每年少于 4 例切除术）进行手术，23.2%的患者被转诊至学术医院。集中治疗后，63.2%的手术治疗患者在两个区域性大容量中心之一接受切除术（每年 15-20 例切除术），13.8%的患者被转诊至学术医院。手术患者的 3 年生存率从 32.0%提高到 45.1%（P=0.004），所有纳入患者的生存率从 13.1%提高到 17.9%（P=0.026）。调整病例组合或（新）辅助治疗后，这些改善仍然存在，且对鳞癌或腺癌患者相似。然而，调整每年医院容量会削弱手术患者的这种关联。
食管和胃贲门癌手术的集中治疗与手术和非手术治疗患者的长期、基于人群的总体生存率的提高有关，显然是通过增加手术量来介导的。
