title: Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities?
abstract: BACKGROUND
  We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care.
  
  
  METHODS
  The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried.
  
  
  RESULTS
  A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P < 0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n = 2,248) derived a treatment benefit at a TF (HR = 1.35, P = 0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P < 0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR = 1.01, P = 0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P = 0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not.
  
  
  CONCLUSIONS
  These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Cheung
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Koniaris
authors.forename: Relin
authors.initials: R
authors.lastname: Yang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhuge
authors.forename: Jill A
authors.initials: JA
authors.lastname: Mackinnon
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Byrne
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome