Overall survival before and after centralization of gastric cancer surgery in the Netherlands

Putten, Margreet van; Nelen, S. D.; Lemmens, Valery; Stoot, Jan H.M.B.; Hartgrink, Henk H.; Gisbertz, Suzanne S.; Bilgen, Ernst Jan Spillenaar; Heisterkamp, Joos; Verhoeven, Rob H.A.; Nieuwenhuijzen, Grard A. P.

doi:10.1002/bjs.10931

Cited by 79 publications

(68 citation statements)

References 37 publications

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“…Second, our study is limited in that longterm outcomes, such as recurrence-free survival and overall survival, were not evaluated. Most recent report from Netherland demonstrated that centralization of gastric cancer surgery was associated with improved both short and long-term outcome [33]. Interestingly, this report showed that survival improved not only for patients who underwent gastrectomy but also for all patients, irrespective of treatment.…”

Section: Discussionmentioning

confidence: 90%

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

et al. 2018

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Background Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system. Methods We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1-22 cases per year), medium (23-51) and high (52-404). Surgeon volume was divided into the 5 groups: 0-3, 4-10, 11-20, 21-50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model. Results We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium-and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0-3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56-0.73, P < 0.001; high: OR 0.42, 95% CI 0.35-0.51, P < 0.001). Conclusions We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.

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Section: Discussionmentioning

confidence: 90%

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

et al. 2018

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“…HER2 testing and the administration of trastuzumab in gastroesophageal cancer might be underexposed within individual centers, because gastroesophageal cancer has a relatively low incidence in Western countries, and only 15-25% of the adenocarcinomas show HER2 overexpression [14][15][16]. In recent years, several studies have been published showing that gastroesophageal cancer patients treated in high-volume hospitals have better outcomes [17][18][19][20][21][22][23][24][25]. Patient volume can therefore be regarded as a proxy for quality of care, possibly due to multimodal expertise and a well-developed organization of care in high-volume hospitals [22,26].…”

Section: Introductionmentioning

confidence: 99%

Increased assessment of HER2 in metastatic gastroesophageal cancer patients: a nationwide population-based cohort study

et al. 2020

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Background Addition of trastuzumab to first-line palliative chemotherapy in gastroesophageal cancer patients with HER2 overexpression has shown to improve survival. Real-world data on HER2 assessment and administration of trastuzumab are lacking. The aim of this study was to assess HER2 testing, trastuzumab administration, and overall survival (OS) in a nationwide cohort of metastatic gastroesophageal cancer patients. Methods Data of patients with synchronous metastatic gastroesophageal adenocarcinoma diagnosed in 2010-2016 that received palliative systemic treatment (n = 2846) were collected from the Netherlands Cancer Registry and Dutch Pathology Registry. The ToGA trial criteria were used to determine HER2 overexpression. Proportions of HER2 tested patients were analyzed between hospital volume categories using Chi-square tests, and over time using trend analysis. OS was tested using the Kaplan Meier method with log rank test. Results HER2 assessment increased annually, from 18% in 2010 to 88% in 2016 (P < 0.01). Median OS increased from 6.9 (2010-2013) to 7.9 months (2014-2016; P < 0.05). Between the hospitals, the proportion of tested patients varied between 29-100%, and was higher in high-volume hospitals (P < 0.01). Overall, 77% of the HER2 positive patients received trastuzumab. Median OS was higher in patients with positive (8.8 months) and negative (7.4 months) HER2 status, compared to non-tested patients (5.6 months; P < 0.05). Conclusion Increased determination of HER2 and administration of trastuzumab have changed daily practice management of metastatic gastroesophageal cancer patients receiving palliative systemic therapy, and possibly contributed to their improved survival. Further increase in awareness of HER2 testing and trastuzumab administration may improve quality of care and patient outcomes.

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“…During the present study interval, there was ongoing centralization of care, which is why the patient's county of residence was chosen as a yearly updated exposure. Other studies 29–31 of total resection rate, and especially the effect of centralization, in pancreatic and gastric cancer also reported associations between a higher total resection rate and survival benefit.…”

Section: Discussionmentioning

confidence: 86%

Geographical differences in cancer treatment and survival for patients with oesophageal and gastro-oesophageal junctional cancers

Hannan

Linder

Kung

et al. 2020

British Journal of Surgery

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Background Only around one‐quarter of patients with cancer of the oesophagus and the gastro‐oesophageal junction (GOJ) undergo surgical resection. This population‐based study investigated the rates of treatment with curative intent and resection, and their association with survival. Methods Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross‐linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with low, intermediate and high rates. Treatment with curative intent was defined as definitive chemoradiation therapy or surgery, with or without neoadjuvant oncological treatment. Overall survival was analysed using a multilevel model based on county of residence at the time of diagnosis. Results Some 5959 patients were included, of whom 1503 (25·2 per cent) underwent surgery. Median overall survival after diagnosis was 7·7, 8·8 and 11·1 months respectively in counties with low, intermediate and high rates of treatment with curative intent. Corresponding survival times for the surgical resection groups were 7·4, 9·3 and 11·0 months. In the multivariable analysis, a higher rate of treatment with curative intent (time ratio 1·17, 95 per cent c.i. 1·05 to 1·30; P < 0·001) and a higher resection rate (time ratio 1·24, 1·12 to 1·37; P < 0·001) were associated with improved survival after adjustment for relevant confounders. Conclusion Patients diagnosed in counties with higher rates of treatment with curative intent and higher rates of surgery had better survival.

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Overall survival before and after centralization of gastric cancer surgery in the Netherlands

Abstract: Centralization of gastric cancer surgery was associated with reduced postoperative mortality and improved survival.

Cited by 79 publications

References 37 publications

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

Increased assessment of HER2 in metastatic gastroesophageal cancer patients: a nationwide population-based cohort study

Geographical differences in cancer treatment and survival for patients with oesophageal and gastro-oesophageal junctional cancers

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