title: Level of hospital care and outcome of gastric cancer: a population-based evaluation of the Munich Cancer Registry.
abstract: BACKGROUND
  Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gastric cancer by different levels of hospital care.
  
  
  METHODS
  Total of 8,601 patients with invasive gastric cancer documented between 1998 and 2012 by the Munich Cancer Registry were evaluated. Tumour and therapy characteristics and outcome were analysed in regard to five levels of hospital care: three levels were defined for general hospitals (level I-III), while university hospitals and speciality hospitals were grouped as separate classes. Survival was investigated using the Kaplan-Meier-method, computing relative survival, and by multivariate Cox proportional hazard regression.
  
  
  RESULTS
  The average age differed between 66 years in university hospitals and 75 years in hospitals providing a basic level of care (level I). No survival differences were found for patients treated in different levels of hospital care in 75 % of the patient cohort, namely the M0 patients. A better survival could only be shown for patients with M1 at diagnosis when treated in a university or level III hospital compared to those treated in other hospitals.
  
  
  CONCLUSIONS
  The outcome difference of M1 patients is most likely caused by selection effects concerning health status differences and not by processes of health care attributable to level of hospital care. Thus, this study demonstrates and confirms appropriate treatment and care of gastric cancer over all levels of hospital care.
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology (IBE), Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany, schlesi@ibe.med.uni-muenchen.de.
authors.forename: Anne
authors.initials: A
authors.lastname: Schlesinger-Raab
authors.forename: André L
authors.initials: AL
authors.lastname: Mihaljevic
authors.forename: Silvia
authors.initials: S
authors.lastname: Egert
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Emeny
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Alexander
authors.initials: A
authors.lastname: Novotny
authors.forename: Natascha C
authors.initials: NC
authors.lastname: Nüssler
authors.forename: Miriam
authors.initials: M
authors.lastname: Rottmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schepp
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmitt
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schubert-Fritschle
authors.forename: Bernhard
authors.initials: B
authors.lastname: Weber
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuhmacher
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome