B153
Intensity of radical resection for gastro oesophageal junction cancer in relation to survival outcomes in England
Henrik Mller1, Victoria Coupland1, Karen Linklater1, Ruth Jack1, Elizabeth Davies1, William Allum2
1King's College London, Thames Cancer Registry, London, UK, 2The Royal Marsden Hospital, London, UK
Background
Radical surgery is attempted in a proportion of gastro oesophageal junction
(GOJ) cancer patients and these selected patients have a good chance of long term
survival. Increasing the resected proportion could possibly increase GOJ cancer
survival in England. This presentation explores survival in relation to the
intensity of radical surgical treatment for GOJ cancer.
Method
We identified 32,442 GOJ cancer patients from cancer registries in England, 1998-2003. Patients with radical surgical treatment were identified from the
hospital episode statistics data. We computed the intensity of radical
resection in GOJ cancer patients in PCT populations in England and assigned a PCT quintile of surgery to each patient. The survival of different
groups of GOJ cancer patients were assessed in relation to
PCT-quintile-of-surgery, age, sex, socio-economic deprivation, and cancer
network, using Cox regression analysis.
Results
Intensity of radical resection ranged from 13% to 31% from the lowest to the
highest PCT-quintile. Survival in the total patient population increased with
radical surgery: upper vs. lower PCT-quintile: HR=0.90; p-trend<0.0001.
Among the subset of resected patients, there was no statistically significant
association (p-trend=0.79).
Conclusion
The data suggest that an increase in the intensity of radical surgery could
plausibly lead to an overall increase in GOJ cancer survival. This analysis
should be repeated for the next five year period as most cancer networks will
have instituted action plans to comply with Improving Outcomes Guidance and
radical surgery will have become more centralised.
