TY - JOUR
T1 - Are academic hospitals better at treating metastatic colorectal cancer?
AU - Atallah, Chady
AU - Oduyale, Oluseye
AU - Stem, Miloslawa
AU - Eltahir, Ahmed
AU - Almaazmi, Hamda H.
AU - Efron, Jonathan
AU - Safar, Bashar
N1 - Funding Information:
Mr. Edwin Lewis provided generous support of Dr. Efron's Department of Surgery Research Fund. Disclaimer: The NCDB is a joint project of the CoC of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the deidentified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Background: There is a strong association between hospital volume and surgical outcomes in resectable colorectal cancer. The purpose of our study was to investigate the association between hospital facility type and survival of patients with metastatic colorectal cancer. Methods: Adults from the National Cancer Database (2010–2015) with a primary diagnosis of colorectal metastases were included and stratified by facility type: community cancer program, comprehensive community cancer program, and academic/research program. The primary outcome was 5-year overall survival, analyzed using Kaplan-Meier survival curves, log-rank test, and the Cox proportional hazards regression model. Results: Among the 52,958 included patients, 13.72% were treated at a community cancer program, 49.89% at a comprehensive community cancer program, and 36.29% at an academic/research program. A significant increase in the proportion of patients being treated in an academic/research program has been observed from 2010 to 2015. An academic/research program tended to use more chemotherapy with colorectal radical resection and liver or lung resection and immunotherapy with chemotherapy. In adjusted analysis, the academic/research program had decreased risk of mortality in comparison to the community cancer program and the comprehensive community cancer program (hazard ratio 0.90, 95% confidence interval 0.86–0.94; 0.87, 0.85–0.90; each P <.001; respectively). Similar results were seen after stratifying by metastatic site and treatment type. Conclusion: The prognosis and overall survival of patients with metastatic disease is better in an academic/research program compared with a community cancer program or a comprehensive community cancer program, with this difference persisting across sites of metastatic disease and treatment types. Further studies are required to validate these results and investigate disparities in the management of metastatic colorectal cancer.
AB - Background: There is a strong association between hospital volume and surgical outcomes in resectable colorectal cancer. The purpose of our study was to investigate the association between hospital facility type and survival of patients with metastatic colorectal cancer. Methods: Adults from the National Cancer Database (2010–2015) with a primary diagnosis of colorectal metastases were included and stratified by facility type: community cancer program, comprehensive community cancer program, and academic/research program. The primary outcome was 5-year overall survival, analyzed using Kaplan-Meier survival curves, log-rank test, and the Cox proportional hazards regression model. Results: Among the 52,958 included patients, 13.72% were treated at a community cancer program, 49.89% at a comprehensive community cancer program, and 36.29% at an academic/research program. A significant increase in the proportion of patients being treated in an academic/research program has been observed from 2010 to 2015. An academic/research program tended to use more chemotherapy with colorectal radical resection and liver or lung resection and immunotherapy with chemotherapy. In adjusted analysis, the academic/research program had decreased risk of mortality in comparison to the community cancer program and the comprehensive community cancer program (hazard ratio 0.90, 95% confidence interval 0.86–0.94; 0.87, 0.85–0.90; each P <.001; respectively). Similar results were seen after stratifying by metastatic site and treatment type. Conclusion: The prognosis and overall survival of patients with metastatic disease is better in an academic/research program compared with a community cancer program or a comprehensive community cancer program, with this difference persisting across sites of metastatic disease and treatment types. Further studies are required to validate these results and investigate disparities in the management of metastatic colorectal cancer.
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U2 - 10.1016/j.surg.2020.05.023
DO - 10.1016/j.surg.2020.05.023
M3 - Article
C2 - 32680747
AN - SCOPUS:85087946338
SN - 0039-6060
VL - 169
SP - 248
EP - 256
JO - Surgery (United States)
JF - Surgery (United States)
IS - 2
ER -