title: Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments.
abstract: OBJECTIVE
  To study the "hospital type-outcome" and "volume-outcome" relationships in patients with esophageal cancer who receive non-surgical treatments.
  
  
  METHODS
  A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, >56 cases) or an upper quartile (>75%) volume of 377 cases (annual volume>94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival.
  
  
  RESULTS
  A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, >94 vs ≤94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P=0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ≤94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of >94 (31.1% and 9.4%, respectively; P=0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume>94 vs ≤94) were independent prognostic factors.
  
  
  CONCLUSIONS
  Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Po-Kuei
authors: PK
authors: Hsu
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Hui-Shan
authors: HS
authors: Chen
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Bing-Yen
authors: BY
authors: Wang
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Shiao-Chi
authors: SC
authors: Wu
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Chao-Yu
authors: CY
authors: Liu
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Chih-Hsun
authors: CH
authors: Shih
authors: Po-Kuei Hsu, Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors: Chia-Chuan
authors: CC
authors: Liu
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cancer registry; Esophageal cancer; Hospital type; Hospital volume; Survival
references: Br J Surg. 2002 Jul;89(7):914-22
references: 12081743
references: Gut. 2014 Sep;63(9):1393-400
references: 24270368
references: Health Serv Res. 1987 Jun;22(2):157-82
references: 3112042
references: Dis Esophagus. 2004;17(4):310-4
references: 15569369
references: Ann Surg. 2006 Feb;243(2):204-11
references: 16432353
references: Eur J Surg Oncol. 2007 Mar;33(2):162-8
references: 17125959
references: Ann Surg. 2007 May;245(5):777-83
references: 17457171
references: Ann Surg Oncol. 2007 May;14(5):1678-87
references: 17294070
references: Arch Surg. 2007 Sep;142(9):829-39
references: 17875837
references: Ann Surg Oncol. 2009 Jul;16(7):1789-98
references: 19370377
references: ANZ J Surg. 2010 May;80(5):317-23
references: 20557504
references: J Gastrointest Surg. 2011 Apr;15(4):558-65
references: 21327531
references: Br J Surg. 2011 Jul;98(7):956-63
references: 21509748
references: Cancer. 2012 Apr 1;118(7):1754-63
references: 22009562
references: J Gastrointest Surg. 2012 May;16(5):1055-63
references: 22089950
references: Br J Surg. 2012 Jul;99(7):954-63
references: 22569956
references: Gut. 2013 Jul;62(7):961-6
references: 23086798
references: Surgery. 2004 Jun;135(6):569-75
references: 15179361