4.6 Article

Multi-institutional Care in Clinical Stage II and III Esophageal Cancer

期刊

ANNALS OF THORACIC SURGERY
卷 115, 期 2, 页码 370-377

出版社

ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2022.06.049

关键词

-

向作者/读者索取更多资源

This study aimed to determine the impact of multi-institutional care on survival in patients with clinical stage II or III esophageal cancer. The results showed that there was no significant difference in survival between patients who received multi-institutional care and those who received care at a single institution. Therefore, for complex cancer care, patients may consider receiving part of their care closer to home, but traveling to surgical centers of excellence should be encouraged.
BACKGROUND Management of clinical stage II or III esophageal cancer requires multidisciplinary care. Multi -institutional care has been associated with worse survival in other malignant diseases. This study aimed to deter-mine the impact of multi-institutional care on survival in patients with stage II or III esophageal cancer. METHODS The 2004 to 2016 National Cancer Database was queried for patients with clinical stage II or III esophageal cancer who received neoadjuvant chemotherapy with or without radiation therapy followed by surgical resection. Pa-tients were stratified into 2 groups: multi-institutional or single-institution care. Survival between groups was compared using Kaplan-Meier and multivariable Cox proportional hazards methods. Multivariable logistic regression was per-formed to identify factors associated with multi-institutional care. RESULTS Overall, 11 399 patients met study criteria: 6569 (57.6%) received multi-institutional care and 4,830 (42.4%) received care at a single institution. In a multivariable analysis, factors associated with multi-institutional care were later year of diagnosis, greater distance from treating facility, residence in an urban or rural setting (vs metro), and residence in states without Medicaid expansion. Care at a single institution was associated with Black race, lack of insurance, and treatment at higher-volume or academic centers. Despite these differences, patients who received multi-institutional care had survival comparable to that in patients who received care at a single institution (HR, 0.97; 95% CI, 0.92-1.03; P [ .30). CONCLUSIONS In this National Cancer Database analysis, multi-institutional care was not associated with inferior overall survival. As complex cancer care becomes more regionalized, patients may consider receiving part of their cancer care closer to home, whereas traveling to surgical centers of excellence should be encouraged.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.6
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据