Disparities in major surgery for esophagogastric cancer among hospitals by case volume

Gabriel, Emmanuel; Narayanan, Sumana; Attwood, Kristopher; Hochwald, Steven N.; Kukar, Moshim; Nurkin, Steven

doi:10.21037/jgo.2018.01.18

Cited by 22 publications

(15 citation statements)

References 38 publications

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“…Minorities and patients with a lower socioeconomic status may be less likely to be treated at the centers that participate in the NCDB. 34,35 The NCDB does not track complications, whether the surgery was elective or emergent, or a patient's functional or nutritional status; therefore, we are unable to ascertain the specific reasons for low compliance in this article. In addition, we can only hypothesize that an increase in integrated cancer networks may improve compliance on the basis of these retrospective data.…”

Section: Discussionmentioning

confidence: 99%

“…Although the nationwide experience and large sample size provided by the NCDB PUF provide unique benefits, there are also significant limitations to this study. Minorities and patients with a lower socioeconomic status may be less likely to be treated at the centers that participate in the NCDB . The NCDB does not track complications, whether the surgery was elective or emergent, or a patient's functional or nutritional status; therefore, we are unable to ascertain the specific reasons for low compliance in this article.…”

Section: Discussionmentioning

confidence: 99%

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Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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Background National Comprehensive Cancer Network (NCCN) guidelines recommend accurate clinical staging, perioperative therapy, and complete lymphadenectomy for patients with stage II to III gastric cancer. However, national compliance remains low. It was hypothesized that integrated cancer networks might improve compliance and outcomes within the community. Methods Patients with stage II to III gastric adenocarcinoma undergoing curative‐intent resection (National Cancer Data Base, 2006‐2015) were examined. Guideline compliance was defined as any perioperative adjunctive therapy, complete lymphadenectomy, complete clinical staging, and complete compliance (all measures). Univariate comparisons and multivariable regression were used to assess factors associated with compliance, and Kaplan‐Meier analysis was used to assess survival. Results There were 27,210 patients identified: 7235 (26.6%) underwent surgery alone, whereas 19,975 (73.4%) received additional therapy. Half (53.1%) had complete lymphadenectomies, whereas complete clinical staging was available for 65.5%. Overall compliance with all 3 measures was 30.1%. Compliance improved by approximately 20% for each measure across the 10‐year study period. Although patients treated at academic programs were most likely to receive concordant care in an adjusted analysis, those treated at integrated care networks were more likely to receive guideline‐concordant care (odds ratio [OR], 0.69) than those treated at comprehensive community programs (OR, 0.48) or community programs (OR, 0.45; all P values <.001). The median overall survival was 45.5 months for patients who received guideline‐concordant care and 32.0 months for those who did not (P < .001, reference for all ORs: academic programs). Conclusions Compliance with guidelines was associated with improved outcomes. Although the rate of compliance with NCCN guidelines is improving, integrated care networks may be an important way of improving the quality of gastric cancer care within the community.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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“…Additionally, we calculated the metastatic lymph nodes ratio (MLR) by dividing the number of mLN by the number of rLN. For more than 95% of patients with gastric cancer in the United States were treated in hospitals with less than 200 cases per year, we defined the SEER cohort to be from low‐volume centers 35 . Meanwhile, CIAH and PUCHI were both among the largest Asian cancer centers, and thus these cohorts were regarded to be from high‐volume centers.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of an artificial neural network prognostic model after gastrectomy for gastric carcinoma: An international multicenter cohort study

Gao

et al. 2020

Cancer Medicine

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Background Recently, artificial neural network (ANN) methods have also been adopted to deal with the complex multidimensional nonlinear relationship between clinicopathologic variables and survival for patients with gastric cancer. Using a multinational cohort, this study aimed to develop and validate an ANN‐based survival prediction model for patients with gastric cancer. Methods Patients with gastric cancer who underwent gastrectomy in a Chinese center, a Japanese center, and recorded in the Surveillance, Epidemiology, and End Results database, respectively, were included in this study. Multilayer perceptron neural network was used to develop the prediction model. Time‐dependent receiver operating characteristic (ROC) curves, area under the curves (AUCs), and decision curve analysis (DCA) were used to compare the ANN model with previous prediction models. Results An ANN model with nine input nodes, nine hidden nodes, and two output nodes was constructed. These three cohort's data showed that the AUC of the model was 0.795, 0.836, and 0.850 for 5‐year survival prediction, respectively. In the calibration curve analysis, the ANN‐predicted survival had a high consistency with the actual survival. Comparison of the DCA and time‐dependent ROC between the ANN model and previous prediction models showed that the ANN model had good and stable prediction capability compared to the previous models in all cohorts. Conclusions The ANN model has significantly better discriminative capability and allows an individualized survival prediction. This model has good versatility in Eastern and Western data and has high clinical application value.

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“…Some meta-analyses suggest a benefit of centralization of esophageal cancer surgery to high-volume institutions in terms of mortality (16). Gabriel and co-authors [2018] have demonstrated that overall survival (OS) was superior for esophageal cancer patients treated at high throughput centers (17). Therefore, selection of such hospitals for NEOCRTEC5010 allowed to reduce the influence of the surgical experience on the results, providing the best possible ones.…”

Section: Editorialmentioning

confidence: 99%

Editorial comments for neoadjuvant chemo-radiotherapy in the treatment of locally advanced squamous cell esophageal cancer

Pischik¹

2018

J. Thorac. Dis

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Disparities in major surgery for esophagogastric cancer among hospitals by case volume

Abstract: This study identified higher numbers of disparate patient factors associated with low/middle volume centers compared to high volume centers, which were associated with worse OS, and further makes the case for performance of esophagectomy and total gastrectomy at high volume centers.

Cited by 22 publications

References 38 publications

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Development and validation of an artificial neural network prognostic model after gastrectomy for gastric carcinoma: An international multicenter cohort study

Editorial comments for neoadjuvant chemo-radiotherapy in the treatment of locally advanced squamous cell esophageal cancer

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