Colorectal Cancer Survival Is Affected By The Public Hospital Type Where Patients Underwent Surgery In Brazil

Karina RIBEIRO, Fundašao Oncocentro de Sao Paulo, Brazil

1 Department of Epidemiology, Fundašao Oncocentro de Sao Paulo, Sao Paulo, Brazil
2 Directorate-General, Fundašao Oncocentro de Sao Paulo, Sao Paulo, Brazil
3 Department of Surgery, University of Sao Paulo Medical School - FMUSP, Sao Paulo, Brazil

Purpose: The aim of this study was to analyze the effect of hospital specialization on five-year overall survival (5y-OS) of patients with surgically treated colorectal cancer. Methods: Study sample included all patients aged 20 years or older with colorectal cancer (tumor sites ICD-O-3 C18-C20 and morphologies 8000/3-8576/3) diagnosed and submitted to surgery during the period 2000-2010. Cases were retrieved from the Central hospital-based Cancer Registry from the state of Sao Paulo, Brazil, summing 18,537 cases who received care in institutions affiliated with the universal health care system (public or non-profit). Patients were classified according to hospital complexity where they received the oncologic surgical care: Centers for High Complexity Care in Oncology (CHCCO), Oncology Care Specialized Units (OCSU) and General Hospitals (GH) (more specialized to less specialized). Clinical group staging (TNM) was available for 17,831 patients. Five-year overall survival was estimated using Kaplan-Meier method and curves were compared using log-rank test. For all statistical tests, alpha=5% was used. Results: Higher 5-y OS was noted for patients treated at CHCCO, compared to those treated at OCSU and GH (53.9% versus 46.9% and 46.3%; p<0.001, respectively). When stratified by clinical stage, differences remained significant, with the same gradient: Stage I = 53.9% versus 46.9% and 46.3%; (p<0.001); Stage II = 68.9% versus 60.5% and 54.5%; (p<0.001); Stage III = 52.2% versus 45.7% and 32.9%; (p<0.001); Stage IV = 13.9% versus 12.1% and 0.0%; (p=0.004). Conclusions: Colorectal specialization was associated with improved survival, irrespectively of disease stage. Our results suggest a relationship between volume and outcome in colorectal cancer surgery, based on hospital and surgeons specialization. These data can contribute to the reorganization of referral system for colorectal cancer diagnosis and treatment in Brazil.