Variables Including Hospital Volume Influence Survival in Esophageal Cancer

Cancer Connect

According to an early online publication in the journal Cancer , patients with esophageal cancer who undergo surgery have a worse survival if treated in hospitals with a lower volume of such procedures. Other factors affecting survival among these patients were also identified.

Cancer of the esophagus (the tube leading to the stomach) is relatively uncommon, but is one of the most aggressive and deadly forms of cancer. According to the American Cancer Society, it was estimated that approximately 14,520 individuals in the U.S. would be diagnosed with esophageal cancer in 2005, and 13,570 would die of the disease.

The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. These types of disease are named for the cells within the esophagus where the cancer develops.

Esophageal cancer is more common among men, African-Americans, smokers, heavy users of alcohol, and patients with Barrett’s esophagus. Currently, surgery is the only potentially curative treatment. Surgery is often combined with chemotherapy and/or radiation therapy.

Results from previous studies have indicated that the volume of certain procedures performed by both hospitals and surgeons affects outcomes in patients with several types of cancers, including esophageal cancer.

Researchers from the Netherlands recently conducted a study to identify specific variables that may be associated with outcomes in esophageal cancer. This study included nearly 3,600 patients who underwent the surgical removal of their esophagus (esophagectomy). They were diagnosed between 1991 and 1996 and had data in the Surveillance, Epidemiology and End Results (SEER)–Medicare database.

  • Older age, other existing medical conditions (diabetes and medical conditions of the heart, lungs kidneys, or liver); radiation with or without chemotherapy prior to surgery; and low hospital volume were all associated with an increased risk of death within 30 days of esophagectomy.

The researchers concluded that these results provide further evidence that hospital volume predicts the risk of death following an esophagectomy among patients with esophageal cancer. Furthermore, patients who are elderly, have other existing medical conditions, or are treated with radiation therapy with or without chemotherapy have an increased risk of death following esophagectomy. Identifying these variables may guide physician and patient decisions on care and follow-up procedures among patients with esophageal cancer undergoing an esophagectomy.

Reference: Steyerberg EW, Neville BA, Koppert LB, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. Journal of Clinical Oncology. 2006;24:4277-4284.