Effect of Hospital Volume With Respect to Performing Gastric Cancer Resection on Recurrence and Survival: Results From the CRITICS Trial. Issue 6 (December 2019)

• Record Type: Journal Article
• Authors: Claassen, Yvette H. M.; van Amelsfoort, Romy M.; Hartgrink, Henk H.; Dikken, Johan L.; de Steur, Wobbe O.; van Sandick, Johanna W.; van Grieken, Nicole C. T.; Cats, Annemieke; Boot, Henk; Trip, Anouk K.; Jansen, Edwin P. M.; Kranenbarg, Elma Meershoek-Klein; Braak, Jeffrey P. B. M.; Putter, Hein; Henegouwen, Mark I. van Berge; Verheij, Marcel; van de Velde, Cornelis J. H.
• Is Part Of: Annals of surgery. Volume 270:Issue 6(2019)
• Publication Date: 2019-12
• Subjects: gastric cancer -- hospital volume -- recurrence -- surgery -- survival; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002940
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: We examined the association between surgical hospital volume and both overall survival (OS) and disease-free survival (DFS) using data obtained from the international CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial. Summary Background Data: In the CRITICS trial, patients with resectable gastric cancer were randomized to receive preoperative chemotherapy followed by adequate gastrectomy and either chemotherapy or chemoradiotherapy. Methods: Patients in the CRITICS trial who underwent a gastrectomy with curative intent in a Dutch hospital were included in the analysis. The annual number of gastric cancer surgeries performed at the participating hospitals was obtained from the Netherlands Cancer Registry; the hospitals were then classified as low-volume (1–20 surgeries/year) or high-volume (≥21 surgeries/year) and matched with the CRITICS trial data. Univariate and multivariate analyses were then performed to evaluate the hazard ratio (HR) between hospital volume and both OS and DFS. Results: From 2007 through 2015, 788 patients were included in the CRITICS trial. Among these 788 patients, 494 were eligible for our study; the median follow-up was 5.0 years. Five-year OS was 59.2% and 46.1% in the high-volume and low-volume hospitals, respectively. Multivariate analysis revealed that undergoing surgery in a high-volume hospital was associated with higher OS [HR = 0.69, 95% confidence interval (CI) = 0.50–0.94, P = 0.020] and DFS (HR = 0.73, 95% CI: 0.54–0.99, P = 0.040). Conclusions: In the CRITICS trial, hospitals with a high annual volume of gastric cancer surgery were associated with higher overall and DFS. These findings emphasize the value of centralizing gastric cancer surgeries in the Western world.