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  • Title: Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities?
    Author: Cheung MC, Koniaris LG, Yang R, Zhuge Y, Mackinnon JA, Byrne MM, Franceschi D.
    Journal: J Surg Oncol; 2010 Jul 01; 102(1):18-26. PubMed ID: 20213687.
    Abstract:
    BACKGROUND: We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care. METHODS: The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried. RESULTS: A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P < 0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n = 2,248) derived a treatment benefit at a TF (HR = 1.35, P = 0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P < 0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR = 1.01, P = 0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P = 0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not. CONCLUSIONS: These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA.
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