Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities?

Michael C. Cheung, Leonidas G. Koniaris, Relin Yang, Ying Zhuge, Jill A. Mackinnon, Margaret M Byrne, Dido Franceschi

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care. Methods: The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried. Results: A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P<0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n=2,248) derived a treatment benefit at a TF (HR=1.35, P=0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P<0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR=1.01, P=0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P=0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not. Conclusions: These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA.

Original languageEnglish
Pages (from-to)18-26
Number of pages9
JournalJournal of Surgical Oncology
Volume102
Issue number1
DOIs
StatePublished - Jul 1 2010

    Fingerprint

Keywords

  • Esophagus cancer
  • Outcomes
  • Squamous cell carcinoma
  • Teaching facility

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this