Do All Patients With Carcinoma of the Esophagus Benefit from Treatment at Teaching Facilities?

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 adenocarcmoma (n = 2,248) derived a treatment benefit at a TF (HR = 1 35. P = (1 003). including an improved 90-day mortality following surgery (21% 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 = 0915). however a trend for reduced 90-day surgical mortality was observed at TF (1 9% vs 5 2% P = 0 062) Multivariate analysis for adenocarcmoma 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 Surg Oncol. 2010.102-8-26 (C) 2010 Wiley-Liss, Inc