Abstract：
BACKGROUND: Esophageal cancer surgery outcomes benefit from higher hospital volumes. Despite the evidence, organization of national health care often is complex and depends on various factors. The volume-outcome results of this population-based study supported national health policy measures regarding concentration of esophageal resections in Belgium.
METHODS: The Belgian Cancer Registry (BCR) database was linked to administrative data on cancer treatment. All Belgian patients with newly diagnosed esophageal cancer in 2008-2018 undergoing resection were allocated to the hospital at which surgery was performed. The study assessed hospital volume association with 90-day mortality and 5-year overall survival, classifying average annual hospital volume of resections as low (LV, <6), medium (MV, 6-19), or high (HV, ≥20) and as a continuous covariate in the regression models.
RESULTS: The study included 4156 patients who had surgery in 79 hospitals (2 HV hospitals [37% of all surgeries], 12 MV hospitals [30% of all surgeries], and 65 LV hospitals [33% of all surgeries]). Adjusted 90-day mortality in HV hospitals was lower than in LV hospitals (odds ratio [OR], 0.37; 95% CI, 0.21-0.65; p = 0.001). Case-mix adjusted 5-year survival was superior in HV versus LV (hazard ratio [HR], 0.43; 95% CI, 0.31-0.60; p < 0.001). The continuous model demonstrated a lower 90-day mortality (OR, 0.40; 95% CI, 0.23-0.71; p = 0.002) and a superior 5-year survival (HR, 0.45; 95% CI, 0.33-0.63; p < 0.001) in hospitals with volumes of 40 or more resections annually.
CONCLUSIONS: Population-based data from the BCR confirmed a strong volume-outcome association for esophageal resections. Improved 5-year survival in centers with annual volumes of 20 or more resections was driven mainly by the achievement of superior 90-day mortality. These findings supported centralization of esophageal resections in Belgium.
METHODS: The Belgian Cancer Registry (BCR) database was linked to administrative data on cancer treatment. All Belgian patients with newly diagnosed esophageal cancer in 2008-2018 undergoing resection were allocated to the hospital at which surgery was performed. The study assessed hospital volume association with 90-day mortality and 5-year overall survival, classifying average annual hospital volume of resections as low (LV, <6), medium (MV, 6-19), or high (HV, ≥20) and as a continuous covariate in the regression models.
RESULTS: The study included 4156 patients who had surgery in 79 hospitals (2 HV hospitals [37% of all surgeries], 12 MV hospitals [30% of all surgeries], and 65 LV hospitals [33% of all surgeries]). Adjusted 90-day mortality in HV hospitals was lower than in LV hospitals (odds ratio [OR], 0.37; 95% CI, 0.21-0.65; p = 0.001). Case-mix adjusted 5-year survival was superior in HV versus LV (hazard ratio [HR], 0.43; 95% CI, 0.31-0.60; p < 0.001). The continuous model demonstrated a lower 90-day mortality (OR, 0.40; 95% CI, 0.23-0.71; p = 0.002) and a superior 5-year survival (HR, 0.45; 95% CI, 0.33-0.63; p < 0.001) in hospitals with volumes of 40 or more resections annually.
CONCLUSIONS: Population-based data from the BCR confirmed a strong volume-outcome association for esophageal resections. Improved 5-year survival in centers with annual volumes of 20 or more resections was driven mainly by the achievement of superior 90-day mortality. These findings supported centralization of esophageal resections in Belgium.
摘要：
背景：食管癌手术结果受益于更高的医院容量。尽管有证据,国家卫生保健的组织往往是复杂的，取决于各种因素。这项基于人群的研究的体积结果支持了比利时关于食管切除术集中的国家卫生政策措施。
方法：比利时癌症登记处（BCR）数据库与癌症治疗的管理数据相关联。所有在2008-2018年接受手术切除的比利时新诊断食管癌患者均被分配到进行手术的医院。该研究评估了医院容量与90天死亡率和5年总生存率的关系。将平均年医院切除量分类为低(LV，<6),中等(MV,6-19),或高(HV，≥20)，并在回归模型中作为连续协变量。
结果：该研究包括79家医院的4156名手术患者（2家HV医院[占所有手术的37％]，12家MV医院[占所有手术的30%]，和65家LV医院[占所有手术的33%])。HV医院的调整后90天死亡率低于LV医院(比值比[OR]，0.37；95%CI，0.21-0.65；p=0.001）。病例组合调整后的5年生存率在HV优于LV(风险比[HR]，0.43；95%CI，0.31-0.60；p<0.001)。连续模型显示了较低的90天死亡率(OR，0.40；95%CI，0.23-0.71；p=0.002）和优越的5年生存率（HR，0.45；95%CI，0.33-0.63；p<0.001）在每年切除40例或更多的医院中。
结论：来自BCR的基于人群的数据证实了食管切除的体积与结果之间的强烈关联。在年切除量为20或更多的中心中，5年生存率的提高主要是由于实现了90天的高死亡率。这些发现支持比利时食管切除术的集中化。
方法：比利时癌症登记处（BCR）数据库与癌症治疗的管理数据相关联。所有在2008-2018年接受手术切除的比利时新诊断食管癌患者均被分配到进行手术的医院。该研究评估了医院容量与90天死亡率和5年总生存率的关系。将平均年医院切除量分类为低(LV，<6),中等(MV,6-19),或高(HV，≥20)，并在回归模型中作为连续协变量。
结果：该研究包括79家医院的4156名手术患者（2家HV医院[占所有手术的37％]，12家MV医院[占所有手术的30%]，和65家LV医院[占所有手术的33%])。HV医院的调整后90天死亡率低于LV医院(比值比[OR]，0.37；95%CI，0.21-0.65；p=0.001）。病例组合调整后的5年生存率在HV优于LV(风险比[HR]，0.43；95%CI，0.31-0.60；p<0.001)。连续模型显示了较低的90天死亡率(OR，0.40；95%CI，0.23-0.71；p=0.002）和优越的5年生存率（HR，0.45；95%CI，0.33-0.63；p<0.001）在每年切除40例或更多的医院中。
结论：来自BCR的基于人群的数据证实了食管切除的体积与结果之间的强烈关联。在年切除量为20或更多的中心中，5年生存率的提高主要是由于实现了90天的高死亡率。这些发现支持比利时食管切除术的集中化。
