TITLE

DOES SIZE MATTER, OR, WHERE SHOULD OESOPHAGO-GASTRIC CANCER BE MANAGED?

AUTHOR(S)
Thompson, A.A.; Park, K.P.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA21
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The Scottish Audit of Gastric and Oesophageal Cancer prospectively collected population based data on 3293 cancers diagnosed over a 2 year period with a minimum 1 year follow up. One aim of the project was to examine whether hospital size was related to outcome. The 53 contributing hospitals were divided by caseload, with small hospitals having significantly less delay in diagnosis than larger institutions (p = 0.001). However, this did not significantly improve subsequent survival (see Table 1). There was no statistically significant difference in postoperative mortality for either gastric or oesophageal cancer by hospital size (Table 2). Overall survival was 32% at 1 year [54% for surgical patients) and 17% at 2 years (33% for surgical patients). The factors adversey affecting survival by multivariate analysis in the surgical patients were American Society of Anaesthesiologists grade 4 (Hazard Ratio 1.35, CIs 1.00 to 1.81, p = 0.047) or 5 (HR 2.46, CI 1.42 to 4.27, p = 0.001) and margin involvement by tumour (HR 1.97 CI 1.32 to 2.96, p = 0.001). Conversely, non-smokers (HR 0.78, CI 0.64 to 0.94, p = 0.01), patients with junctional cancers (HR 0.7, CI 0.51 to 0.95, p = 0.021), and those with a history of H pylori infection (HR 0.79, CI 0.63 to 0.99, p = 0.04) did better. Following univariate, case mix adjusted and multivariate analysis, there was no difference in survival according to the size of the hospital oF presentation or hospital of surgery. In combination with data emerging from elsewhere, the guidance on the organisation of oesophago-gastric cancer services in the UK should be reviewed.
ACCESSION #
9747396

 

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