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Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship.

Authors
 Hyeok Choi  ;  Seong-Yoon Yang  ;  Hee-Seung Cho  ;  Woorim Kim  ;  Eun-Cheol Park  ;  Kyu-Tae Han 
Citation
 WORLD JOURNAL OF SURGICAL ONCOLOGY, Vol.15(1) : 1-9, 2017 
Journal Title
 WORLD JOURNAL OF SURGICAL ONCOLOGY 
Issue Date
2017
MeSH
Adult ; Aged ; Clinical Decision-Making ; Female ; Follow-Up Studies ; Gastrectomy/mortality* ; Hospital Mortality/trends* ; Hospitals, High-Volume/statistics & numerical data* ; Hospitals, Low-Volume/statistics & numerical data* ; Humans ; Male ; Middle Aged ; Prognosis ; Stomach Neoplasms/mortality* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Survival Rate
Keywords
Cox proportional hazard models ; Gastrectomy ; High-volume hospitals ; Mortality ; Stomach neoplasms
Abstract
BACKGROUND: Many studies have assessed the volume-outcome relationship in cancer patients, but most focused on better outcomes in higher volume groups rather than identifying a specific threshold that could assist in clinical decision-making for achieving the best outcomes. The current study suggests an optimal volume for achieving good outcome, as an extension of previous studies on the volume-outcome relationship in stomach cancer patients. METHODS: We used National Health Insurance Service (NHIS) Sampling Cohort data during 2004-2013, comprising healthcare claims for 2550 patients with newly diagnosed stomach cancer. We conducted survival analyses adopting the Cox proportional hazard model to investigate the association of three threshold values for surgical volume of stomach cancer patients for cancer-specific mortality using the Youden index. RESULTS: Overall, 17.10% of patients died due to cancer during the study period. The risk of mortality among patients who received surgical treatment gradually decreased with increasing surgical volume at the hospital, while the risk of mortality increased again in "high" surgical volume hospitals, resulting in a j-shaped curve (mid-low = hazard ratio (HR) 0.773, 95% confidence interval (CI) 0.608-0.983; mid-high = HR 0.541, 95% CI 0.372-0.788; high = HR 0.659, 95% CI 0.473-0.917; ref = low). These associations were especially significant in regions with unsubstantial surgical volumes and less severe cases. CONCLUSION: The optimal surgical volume threshold was about 727.3 surgical cases for stomach cancer per hospital over the 1-year study period in South Korea. However, such positive effects decreased after exceeding a certain volume of surgeries.
Files in This Item:
T201702245.pdf Download
DOI
10.1186/s12957-017-1203-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160371
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