Level of hospital care and outcome of gastric cancer: a population-based evaluation of the Munich Cancer Registry

Background Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gas...

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Bibliographic Details
Published in:Journal of cancer research and clinical oncology 2014-05, Vol.140 (5), p.789-800
Main Authors: Schlesinger-Raab, Anne, Mihaljevic, André L., Egert, Silvia, Emeny, Rebecca T., Jauch, Karl-Walter, Kleeff, Jörg, Novotny, Alexander, Nüssler, Natascha C., Rottmann, Miriam, Schepp, Wolfgang, Schmitt, Wolfgang, Schubert-Fritschle, Gabriele, Weber, Bernhard, Schuhmacher, Christoph, Engel, Jutta
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cancer Research
Clinical outcomes
Female
Gastric cancer
Germany
Hematology
Hospital Mortality
Hospitalization
Hospitals
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article – Cancer Research
Prognosis
Registries
Stomach Neoplasms - epidemiology
Stomach Neoplasms - pathology
Stomach Neoplasms - therapy
Treatment Outcome
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Summary:Background Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gastric cancer by different levels of hospital care. Materials and methods Total of 8,601 patients with invasive gastric cancer documented between 1998 and 2012 by the Munich Cancer Registry were evaluated. Tumour and therapy characteristics and outcome were analysed in regard to five levels of hospital care: three levels were defined for general hospitals (level I–III), while university hospitals and speciality hospitals were grouped as separate classes. Survival was investigated using the Kaplan–Meier-method, computing relative survival, and by multivariate Cox proportional hazard regression. Results The average age differed between 66 years in university hospitals and 75 years in hospitals providing a basic level of care (level I). No survival differences were found for patients treated in different levels of hospital care in 75 % of the patient cohort, namely the M0 patients. A better survival could only be shown for patients with M1 at diagnosis when treated in a university or level III hospital compared to those treated in other hospitals. Conclusion The outcome difference of M1 patients is most likely caused by selection effects concerning health status differences and not by processes of health care attributable to level of hospital care. Thus, this study demonstrates and confirms appropriate treatment and care of gastric cancer over all levels of hospital care.
ISSN:0171-5216
1432-1335
DOI:10.1007/s00432-014-1632-4