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Geographical differences in cancer treatment and survival for patients with oesophageal and gastro-oesophageal junctional cancers

Jestin Hannan, C ; Linder, G ; Kung, C-H ; Johansson, J LU ; Lindblad, M and Hedberg, J (2020) In The British journal of surgery 107(11). p.1500-1509
Abstract

BACKGROUND: Only around one-quarter of patients with cancer of the oesophagus and the gastro-oesophageal junction (GOJ) undergo surgical resection. This population-based study investigated the rates of treatment with curative intent and resection, and their association with survival.

METHODS: Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross-linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with... (More)

BACKGROUND: Only around one-quarter of patients with cancer of the oesophagus and the gastro-oesophageal junction (GOJ) undergo surgical resection. This population-based study investigated the rates of treatment with curative intent and resection, and their association with survival.

METHODS: Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross-linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with low, intermediate and high rates. Treatment with curative intent was defined as definitive chemoradiation therapy or surgery, with or without neoadjuvant oncological treatment. Overall survival was analysed using a multilevel model based on county of residence at the time of diagnosis.

RESULTS: Some 5959 patients were included, of whom 1503 (25·2 per cent) underwent surgery. Median overall survival after diagnosis was 7·7, 8·8 and 11·1 months respectively in counties with low, intermediate and high rates of treatment with curative intent. Corresponding survival times for the surgical resection groups were 7·4, 9·3 and 11·0 months. In the multivariable analysis, a higher rate of treatment with curative intent (time ratio 1·17, 95 per cent c.i. 1·05 to 1·30; P < 0·001) and a higher resection rate (time ratio 1·24, 1·12 to 1·37; P < 0·001) were associated with improved survival after adjustment for relevant confounders.

CONCLUSION: Patients diagnosed in counties with higher rates of treatment with curative intent and higher rates of surgery had better survival.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Adenocarcinoma/mortality, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell/mortality, Chemoradiotherapy/statistics & numerical data, Esophageal Neoplasms/mortality, Esophagectomy/statistics & numerical data, Esophagogastric Junction/surgery, Female, Follow-Up Studies, Healthcare Disparities/statistics & numerical data, Humans, Male, Middle Aged, Neoadjuvant Therapy/statistics & numerical data, Practice Patterns, Physicians'/statistics & numerical data, Registries, Retrospective Studies, Stomach Neoplasms/mortality, Survival Analysis, Sweden/epidemiology, Treatment Outcome
in
The British journal of surgery
volume
107
issue
11
pages
1500 - 1509
publisher
Oxford University Press
external identifiers
  • scopus:85085695442
  • pmid:32484241
ISSN
1365-2168
DOI
10.1002/bjs.11671
language
English
LU publication?
no
additional info
© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
id
7f30da28-a180-4ae1-986c-892965e17eb5
date added to LUP
2022-05-31 16:22:19
date last changed
2024-03-06 07:48:41
@article{7f30da28-a180-4ae1-986c-892965e17eb5,
  abstract     = {{<p>BACKGROUND: Only around one-quarter of patients with cancer of the oesophagus and the gastro-oesophageal junction (GOJ) undergo surgical resection. This population-based study investigated the rates of treatment with curative intent and resection, and their association with survival.</p><p>METHODS: Patients diagnosed with oesophageal and GOJ cancer between 2006 and 2015 in Sweden were identified from the National Register for Oesophageal and Gastric Cancer (NREV). The NREV was cross-linked with several national registries to obtain information on additional exposures. The annual proportion of patients undergoing treatment with curative intent and surgical resection in each county was calculated, and the counties divided into groups with low, intermediate and high rates. Treatment with curative intent was defined as definitive chemoradiation therapy or surgery, with or without neoadjuvant oncological treatment. Overall survival was analysed using a multilevel model based on county of residence at the time of diagnosis.</p><p>RESULTS: Some 5959 patients were included, of whom 1503 (25·2 per cent) underwent surgery. Median overall survival after diagnosis was 7·7, 8·8 and 11·1 months respectively in counties with low, intermediate and high rates of treatment with curative intent. Corresponding survival times for the surgical resection groups were 7·4, 9·3 and 11·0 months. In the multivariable analysis, a higher rate of treatment with curative intent (time ratio 1·17, 95 per cent c.i. 1·05 to 1·30; P &lt; 0·001) and a higher resection rate (time ratio 1·24, 1·12 to 1·37; P &lt; 0·001) were associated with improved survival after adjustment for relevant confounders.</p><p>CONCLUSION: Patients diagnosed in counties with higher rates of treatment with curative intent and higher rates of surgery had better survival.</p>}},
  author       = {{Jestin Hannan, C and Linder, G and Kung, C-H and Johansson, J and Lindblad, M and Hedberg, J}},
  issn         = {{1365-2168}},
  keywords     = {{Adenocarcinoma/mortality; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell/mortality; Chemoradiotherapy/statistics & numerical data; Esophageal Neoplasms/mortality; Esophagectomy/statistics & numerical data; Esophagogastric Junction/surgery; Female; Follow-Up Studies; Healthcare Disparities/statistics & numerical data; Humans; Male; Middle Aged; Neoadjuvant Therapy/statistics & numerical data; Practice Patterns, Physicians'/statistics & numerical data; Registries; Retrospective Studies; Stomach Neoplasms/mortality; Survival Analysis; Sweden/epidemiology; Treatment Outcome}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1500--1509}},
  publisher    = {{Oxford University Press}},
  series       = {{The British journal of surgery}},
  title        = {{Geographical differences in cancer treatment and survival for patients with oesophageal and gastro-oesophageal junctional cancers}},
  url          = {{http://dx.doi.org/10.1002/bjs.11671}},
  doi          = {{10.1002/bjs.11671}},
  volume       = {{107}},
  year         = {{2020}},
}