Abstract 1449P
Background
An association between hospital volume and outcomes of esophagogastric cancer patients treated with first-line palliative systemic treatment has earlier been observed. The aim of this study was to analyze the association between hospital volume and the real-world use of beyond first-line systemic treatment in esophagogastric adenocarcinoma, and its impact on overall survival (OS).
Methods
Synchronous metastatic esophagogastric adenocarcinoma patients treated with first-line systemic therapy (2010-2017) were selected from the Netherlands Cancer Registry. Hospitals were categorized in quartiles based on the volume of systemic treatment administration in esophagogastric cancer, and above and below the median proportion of patients that received beyond first-line treatment. The association between hospital volume and the use of beyond first-line treatment was assessed using trend analyses, and with OS using Kaplan Meier curves with log rank test and multivariable Cox proportional hazard regression analyses.
Results
Beyond first-line systemic therapy was administered in 606 (25%) of 2,466 included patients. The interhospital variation of beyond-first line treatment use was 0-71%. The probability of receiving beyond-first line treatment was higher in high volume (28%) versus low volume (17%) esophagogastric cancer treatment centers (P<0.001). Median OS since start of first-line treatment of all 1,529 patients treated in hospitals with a high proportion of beyond first-line treatment administration was 7.9 months, and 6.1 months in hospitals with a low administration (n=937; P<0.001). Adjusted hazard ratios of patients treated with beyond first-line treatment in the three lowest compared to the highest hospital volume were 1.46 (95%CI 0.98-2.18), 1.39 (95%CI 1.03-1.47) and 1.18 (95%CI 0.94-1.47), respectively.
Conclusions
In metastatic esophagogastric cancer, a higher hospital volume was associated with increased use of beyond first-line treatment. Superior OS was observed in patients treated in hospitals that administered beyond first-line treatment frequently. Our findings support the suggested relation between hospital volume and patient outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Eli Lilly, BMS.
Disclosure
R.H. Verhoeven: Research grant/Funding (institution): BMS; Research grant/Funding (institution): Roche. N. Haj Mohammad: Advisory/Consultancy: BMS; Advisory/Consultancy: MSD; Advisory/Consultancy, Research grant/Funding (institution): Servier; Advisory/Consultancy: Lilly. J. de vos-Geelen: Non-remunerated activity/ies: BTG; Advisory/Consultancy: Shire; Advisory/Consultancy, Research grant/Funding (institution): Servier. T. Van Voorthuizen: Non-remunerated activity/ies: Astellas; Non-remunerated activity/ies: Ipsen; Non-remunerated activity/ies: Roche; Non-remunerated activity/ies: Bayer. V.E.P.P. Lemmens: Research grant/Funding (institution): Roche. M.G.H. van Oijen: Research grant/Funding (institution): BMS; Research grant/Funding (institution): Amgen; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): Roche; Research grant/Funding (institution): Nordic; Research grant/Funding (institution): Merck; Research grant/Funding (institution): Servier. H.W.M. van Laarhoven: Research grant/Funding (institution): Bayer; Advisory/Consultancy, Research grant/Funding (institution): BMS; Advisory/Consultancy, Research grant/Funding (institution): Celgene; Advisory/Consultancy, Research grant/Funding (institution): Lilly; Advisory/Consultancy, Research grant/Funding (institution): Merck; Research grant/Funding (institution): MSD; Advisory/Consultancy, Research grant/Funding (institution): Nordic; Research grant/Funding (institution): Philips; Research grant/Funding (institution): Roche; Advisory/Consultancy, Research grant/Funding (institution): Servier. All other authors have declared no conflicts of interest.