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  • br Risk of year mortality

    2020-08-12


    Risk of 5-year mortality
    The HRs of disease-specific 5-year mortality and all-cause 5-year mortality were similar in the complete-case and imputated analyses. Therefore, only the HRs based on multiple imputation are presented. The sensitivity analysis excluding patients with any previous cancer yielded similar results to those where these pa-tients were included, thus only the latter results are presented.
    Upper gastrointestinal cancers
    Esophageal cancer
    Higher hospital volume of esophageal cancer surgery did not decrease the risk of mortality in most overall analyses, and the disease-specific 5-year mortality was 1.01 (95% CI 0.82e1.24) when comparing the highest hospital volume quartile with the lowest (Table 2). However, a decreased all-cause 5-year mortality was found in the 3rd quartile of hospital volume category compared to the 1st quartile (adjusted HR 0.82, 95% CI 0.68e0.99) (Table 2), and the effect modification analyses indicated a decreased disease-
    Hospital volume (in quartiles) for upper gastrointestinal cancer in relation to 5-year mortality.
    Cancer type Hospital volume Average annual volume Number of patients (%) Disease-specific 5-year mortality All-cause 5-year mortality
    Hazard ratio (95% confidence interval)a
    Crude Adjusted Crude Adjusted
    a Adjusted for age, sex, comorbidity, calendar year of surgery and tumor stage.
    Please cite this SalvinorinA article as: Gottlieb-Vedi E et al., Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis, European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2019.03.016
    4 E. Gottlieb-Vedi et al. / European Journal of Surgical Oncology xxx (xxxx) xxx
    Table 3
    Hospital volume (in quartiles) for hepato-pancreatico-biliary cancer in relation to 5-year mortality.
    Cancer type Hospital group Average annual volume Number of patients (%) Disease-specific 5-year mortality All-cause 5-year mortality
    Hazard ratio (95% confidence interval)a
    Crude Adjusted Crude Adjusted
    a Adjusted for age, sex, comorbidity, calendar year of surgery and tumor stage.
    specific 5-year mortality in all higher hospital volume quartiles compared to the 1st quartile in patients with tumor stage III-IV; particularly pronounced in the 3rd quartile (adjusted HR 0.70, 95% CI 0.51e0.95) (Table 5).
    Gastric cancer
    Higher hospital volume of surgery for gastric cancer did not decrease any of the 5-year mortality outcomes (Table 2). The disease-specific 5-year mortality was similar when comparing the 4th and 1st quartile volume hospitals (adjusted HR 1.01, 95% CI 0.85e1.21), and the effect modification analyses revealed no sta-tistically significant associations (Table 5).
    Hepato-pancreatico-biliary cancers
    Liver cancer
    Higher hospital volume of liver cancer surgery did not decrease the 5-year mortality outcomes (Table 3). The adjusted HR of disease-specific 5-year mortality comparing the 4th and 1st hos-pital volume quartiles was 0.92 (95% CI 0.58e1.46), and the effect modification analyses revealed no statistically significantly decreased HRs (Table 5).
    Pancreatic cancer
    Higher hospital volume for pancreatic cancer surgery did not decrease the 5-year mortality outcomes in most analyses (Table 3).
    When comparing the 4th and 1st hospital volume categories, the adjusted HR for disease-specific 5-year mortality was 0.94 (95% CI 0.77e1.15). However, the effect modification analyses suggested decreased disease-specific 5-year mortality in patients with a tap root Charlson comorbidity score 2 when higher volume hospitals were compared with the 1st quartile (Table 3), and a statistically signif-icant decrease was found for the 4th quartile hospitals (adjusted HR 0.55, 95% CI 0.33e0.90). Although not statistically significant, the disease-specific 5-year mortality was possibly decreased for pa-tients with tumor stage III-IV when comparing the 4th and 1st hospital volume quartiles (adjusted HR 0.82, 95% CI 0.62e1.07) (Table 5).
    Bile duct cancer
    Higher hospital volume of surgery for bile duct cancer did not decrease the 5-year mortality (Table 3). The comparison of the 4th and 1st hospital volume quartiles showed an adjusted HR of disease-specific 5-year mortality of 1.22 (95% CI 0.75e1.99). The effect modification analyses revealed no statistically significant associations (Table 5).
    Lower gastrointestinal cancers
    Small bowel cancer
    Higher hospital volume for small bowel cancer surgery did not decrease the 5-year mortality outcomes (Table 4). For disease-
    Hospital volume (in quartiles) for lower gastrointestinal cancer in relation to 5-year mortality.