The Volume-Outcome Effect Calls for Centralization of Care in Esophageal Adenocarcinoma: Results From a Large National Cancer Registry
Samuel Han, Jennifer M. Kolb, Patrick Hosokawa, Chloe Friedman, Charlie Fox, Frank I. Scott, Christopher H. Lieu, Ravy K. Vajravelu, Martin D. McCarter, Caitlin C. Murphy, Michael B. Cook, Ana Gleisner, Gary W. Falk, David A. Katzka, Sachin Wani
Abstract
INTRODUCTION: Using the National Cancer Database, we assessed the relationship between facility overall esophageal adenocarcinoma (EAC) case volume and survival. METHODS: We categorized facilities into volume quintiles based on annual EAC patient volume and performed a multivariable Cox proportional hazards regression between facility patient volume and survival. RESULTS: In a cohort of 116,675 patients, facilities with higher vs lower (≥25 vs 1-4 cases) annual EAC patient volume demonstrated improved survival (adjusted hazard ratio: 0.80. 95% confidence interval: 0.70-0.91). DISCUSSION: This robust volume-outcome effect calls for centralization of care for EAC patients at high annual case volume facilities.