Hospital volume and beyond first-line palliative systemic treatment in metastatic oesophagogastric adenocarcinoma: A population-based study

Willemieke P. M. Dijksterhuis, Rob H. A. Verhoeven, Marieke Pape, Marije Slingerland, Nadia Haj Mohammad, Judith de Vos-Geelen, Laurens V. Beerepoot, Theo van Voorthuizen, Geert-Jan Creemers, Valery E. P. P. Lemmens, Martijn G. H. van Oijen, Hanneke W. M. van Laarhoven*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Beyond first-line palliative systemic treatment can be beneficial to selected oesophagogastric cancer patients, but experience with its administration may be limited and vary among hospitals. In a population-based study, we analysed the association between hospital systemic treatment volume and administration of beyond first-line treatment in oesophagogastric adenocarcinoma, as well as the effect on overall survival (OS).

Methods: Synchronous metastatic oesophagogastric adenocarcinoma patients (2010-2017) were selected from the Netherlands Cancer Registry. Hospitals were categorised in volumes quartiles. The association between hospital systemic treatment volume and the use of beyond first-line treatment was assessed using trend and multivariable logistic regression analyses. OS was compared between hospitals with high and low beyond first-line treatment administration and treatment strategies using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard regression.

Results: Beyond first-line treatment was administered in 606 of 2,466 patients who received first-line treatment, and increased from 20% to 31% between 2010 and 2017 (P <0.001). The lowest hospital volumes were independently associated with lower beyond first-line treatment administration compared to the highest volume (OR 0.62, 95% CI 0.39-0.99; OR 0.67, 95% CI 0.48-0.95). Median OS was higher in all patients treated in hospitals with a high versus low beyond first-line treatment administration (7.9 versus 6.2 months, P <0.001). Second-line paclitaxel/ramucirumab was administered most frequently and independently associated with longer OS compared to taxane monotherapy (HR 0.74, 95% CI 0.59-0.92).

Conclusion: Higher hospital volume was associated with increased beyond first-line treatment administration in oesophagogastric adenocarcinoma. Second-line paclitaxel/ramucirumab resulted in longer survival compared to taxane monotherapy. (C) 2020 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)107-118
Number of pages12
JournalEuropean Journal of Cancer
Publication statusPublished - Nov 2020


  • oesophageal neoplasms
  • Gastric neoplasms
  • Drug therapy
  • Palliative treatment
  • LIFE
  • CARE

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