AUTHOR=Lei Ling-Ling , Song Xin , Zhao Xue-Ke , Xu Rui-Hua , Wei Meng-Xia , Sun Lin , Wang Pan-Pan , Yang Miao-Miao , Hu Jing-Feng , Zhong Kan , Han Wen-Li , Han Xue-Na , Fan Zong-Min , Wang Ran , Li Bei , Zhou Fu-You , Wang Xian-Zeng , Zhang Li-Guo , Bao Qi-De , Qin Yan-Ru , Chang Zhi-Wei , Ku Jian-Wei , Yang Hai-Jun , Yuan Ling , Ren Jing-Li , Li Xue-Min , Wang Li-Dong 

TITLE=Long-term effect of hospital volume on the postoperative prognosis of 158,618 patients with esophageal squamous cell carcinoma in China

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1056086

DOI=10.3389/fonc.2022.1056086

ISSN=2234-943X

ABSTRACT=Abstract 
BACKGROUND 
The impact of hospital volume on the long-term survival of esophageal squamous cell carcinoma (ESCC) has not been well assessed in China, especially for stage I–III stage ESCC. We performed a large sample size study to assess the relationships between hospital volume and the effectiveness of ESCC treatment and the hospital volume value at the lowest risk of all-cause mortality after esophagectomy in China.

AIM
To investigate the prognostic value of hospital volume for assessing postoperative long-term survival of ESCC patients in China.

METHODS
The date of 158,618 patients with ESCC were collected from a database (1973–2020) established by the State Key Laboratory for Esophageal Cancer Prevention & Treatment, the database includes 500,000 patients with detailed clinical information of pathological diagnosis and staging, treatment approaches and survival follow-up for esophageal and gastric cardia cancers. Intergroup comparisons of patient and treatment characteristics were conducted with the X2 test and analysis of variance. The Kaplan-Meier method with the log-rank test was used to draw the survival curves for the variables tested. A Multivariate Cox proportional hazards regression model was used to analyze the independent prognostic factors for overall survival. The primary outcome was all-cause mortality.
RESULTS 
In both 1973-1996 and 1997-2020, patients with stage I-III stage ESCC who underwent surgery in high volume hospitals had better survival than those who underwent surgery in low volume hospitals (both P<0.05). And high volume hospital was an independent factor for better prognosis in ESCC patients. The relationship between hospital volume and the risk of all-cause mortality was half-U-shaped, but overall, hospital volume was a protective factor for esophageal cancer patients after surgery (HR<1). The concentration of hospital volume associated with the lowest risk of all-cause mortality was 1027 cases/year in the overall enrolled patients.

CONCLUSION 
Hospital volume can be used as an indicator to predict the postoperative survival of ESCC patients. Our results suggest that the centralized management of esophageal cancer surgery is meaningful to improve the survival of ESCC patients in China, but the hospital volume should preferably not be higher than 1027 cases/year.