Treatment of Gastric Cancer According to the Complexity of the Hospital Oncology Unit: Analysis of 33,774 Patients Over Two Decades

Abstract

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.