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Comparative Study
. 2024 Dec 16:37:e1846.
doi: 10.1590/0102-6720202400052e1846. eCollection 2024.

TREATMENT OF GASTRIC CANCER ACCORDING TO THE COMPLEXITY OF THE HOSPITAL ONCOLOGY UNIT: ANALYSIS OF 33,774 PATIENTS OVER TWO DECADES

Marcus Fernando Kodama Pertille Ramos  1 , Marina Alessandra Pereira  1 , Carolina Terra de Moraes Luizaga  2 , Valeria Lombardo  2 , Valter Bezerra Leite  2 , Stela Verzinhasse Peres  2 , Rodrigo Nascimento Pinheiro  3 , Ulysses Ribeiro Junior  1   2
Affiliations
Comparative Study

TREATMENT OF GASTRIC CANCER ACCORDING TO THE COMPLEXITY OF THE HOSPITAL ONCOLOGY UNIT: ANALYSIS OF 33,774 PATIENTS OVER TWO DECADES

Marcus Fernando Kodama Pertille Ramos et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: The hospitals' volume, specialization, availability of all oncological services, and experience in performing complex surgeries have a favorable impact on gastric cancer (GC) treatment.

Aims: The aim of this study was to compare the results of GC treatment according to the type of oncological hospital in the State of São Paulo.

Methods: Patients diagnosed with GC between 2000 and 2022 in qualified hospitals for cancer treatment were evaluated by data extracted from the hospital cancer registry. Patients were assessed according to the type of hospital for cancer treatment: Oncology High Complexity Assistance Unit (UNACON) and Oncology High Complexity Care Center (CACON), which has greater complexity.

Results: Among the 33,774 patients, 23,387 (69.2%) were treated at CACONs and 10,387 (30.8%) in UNACONs. CACON patients were younger, had a higher level of education, and had a more advanced cTNM stage compared to UNACON (all p<0.001, p<0.05). The time from diagnosis to treatment was over 60 days in 49.8% of CACON's patients and 39.4% of UNACON's (p<0.001, p<0.05). Surgical treatment was performed in 18,314 (54.2%) patients. The frequency pN0 (40.3 vs 32.4%) and pTNM stage I (23 vs 19.5%) were higher in CACON. There was no difference in overall survival (OS) between all adenocarcinoma cases treated at CACON and UNACON (9.3 vs 10.3 months, p=0.462, p>0.05). However, considering only patients who underwent curative surgery, the OS of patients treated at CACON was better (24.4 vs 18 months, p<0.001).

Conclusions: Patients with GC who underwent gastrectomy at CACONs had better survival outcomes, suggesting that the centralization of complex cancer surgery may be beneficial.

RACIONAL:: O volume do Hospital, especialização, disponibilidade serviços oncológicos e experiência na realização de cirurgias complexas têm impacto favorável no tratamento do câncer gástrico (CG).

OBJETIVOS:: Comparar resultados do tratamento do CG de acordo com o tipo de Hospital oncológico no Estado de São Paulo.

MÉTODOS:: Pacientes diagnosticados com CG entre 2000 e 2022 foram avaliados por dados extraídos do Registro Hospitalar de Câncer, de acordo com o tipo de Unidade de tratamento: Unidade de Assistência de Alta Complexidade Oncológica (UNACON) e Centro de Assistência de Alta Complexidade Oncológica (CACON), que tem maior complexidade.

RESULTADOS:: Entre os 33.774 pacientes, 23.387 (69,2%) foram tratados em CACONs e 10.387 (30,8%) em UNACONs. Pacientes no CACON eram mais jovens, tinham maior nível de escolaridade e cTNM mais avançado em comparação ao UNACON (todos p<0,001). O tempo do diagnóstico ao tratamento foi superior a 60 dias em 49,8% dos pacientes do CACON e 39,4% dos do UNACON (p<0,001). O tratamento cirúrgico foi realizado em 18.314 (54,2%) pacientes. A frequência de pN0 (40,3 vs 32,4%) e pTNM I (23 vs 19,5%) foi maior no CACON. Não houve diferença na sobrevida global (SG) entre todos os casos de adenocarcinoma tratados no CACON e no UNACON (9,3 vs 10,3 meses, p=0,462, p>0.05). No entanto, considerando apenas os pacientes submetidos à cirurgia, a SG daqueles tratados no CACON foi melhor (24,4 vs 18 meses, p<0,001, p<0.05).

CONCLUSÕES:: Pacientes com GC submetidos à gastrectomia em CACONs apresentaram melhores resultados de sobrevida, sugerindo que a centralização de cirurgias oncológicas complexas pode ser benéfica.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Study flowchart.
Figure 2
Figure 2. Overall survival according to UNACON and CACON. (A) All patients and (B) only patients who underwent surgery.
Figure 3
Figure 3. Overall survival for UNACON and CACON according to TNM clinical stage.
See this image and copyright information in PMC

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