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Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship
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 suggest...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513131/ https://www.ncbi.nlm.nih.gov/pubmed/28716145 http://dx.doi.org/10.1186/s12957-017-1203-7 |
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author | Choi, Hyeok Yang, Seong-Yoon Cho, Hee-Seung Kim, Woorim Park, Eun-Cheol Han, Kyu-Tae |
author_facet | Choi, Hyeok Yang, Seong-Yoon Cho, Hee-Seung Kim, Woorim Park, Eun-Cheol Han, Kyu-Tae |
author_sort | Choi, Hyeok |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5513131 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55131312017-07-19 Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship Choi, Hyeok Yang, Seong-Yoon Cho, Hee-Seung Kim, Woorim Park, Eun-Cheol Han, Kyu-Tae World J Surg Oncol Research 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. BioMed Central 2017-07-17 /pmc/articles/PMC5513131/ /pubmed/28716145 http://dx.doi.org/10.1186/s12957-017-1203-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Choi, Hyeok Yang, Seong-Yoon Cho, Hee-Seung Kim, Woorim Park, Eun-Cheol Han, Kyu-Tae Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title | Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title_full | Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title_fullStr | Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title_full_unstemmed | Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title_short | Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
title_sort | mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513131/ https://www.ncbi.nlm.nih.gov/pubmed/28716145 http://dx.doi.org/10.1186/s12957-017-1203-7 |
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