ImportanceOngoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care.ObjectiveTo determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally at low-volume centers (LVC).Design, Setting, and ParticipantsThis cohort study considered data for all patients diagnosed with stage I through III esophageal adenocarcinoma in the 2010-2021 National Cancer Database. Patients were stratified based on distance traveled to receive care and the annual esophagectomy volume at the treating hospital: the travel-HVC cohort included patients in the top 25th percentile of travel burden who received care at centers in the top volume quartile, and the local-LVC cohort represented those in the bottom 25th percentile of travel burden who were treated at centers in the lowest volume quartile. Data were analyzed from July 2023 to January 2024.Main Outcomes and MeasuresThe primary end points were overall survival at 1 year and 5 years. Secondary end points included perioperative outcomes and factors linked with traveling to receive care.ResultsOf 17 970 patients, 2342 (13%) comprised the travel-HVC cohort, and 1969 (11%), the local-LVC cohort. The median (IQR) age was 65 (58-71) years; 3748 (87%) were male and 563 (13%) were female. After risk adjustment and with care at local LVCs as the reference, traveling to HVC was associated with superior survival at 1 year (hazard ratio for mortality [HR], 0.69; 95% CI, 0.58-0.83) and 5 years (HR, 0.80; 95% CI, 0.70-0.90). Stratifying by stage, traveling to HVCs was associated with comparable outcomes for stage I disease but reduced mortality for stage III (1-year HR, 0.72; 95% CI, 0.60-0.87; 5-year HR, 0.83; 95% CI, 0.74-0.93). Further, traveling to HVC was associated with greater lymph node harvest (β, 5.08 nodes; 95% CI, 3.78-6.37) and likelihood of margin-negative resection (adjusted odds ratio, 1.83; 95% CI, 1.29-2.60).Conclusions and RelevanceTraveling to HVCs for esophagectomy was associated with improved 1-year and 5-year survival compared with receiving care locally at LVCs, particularly among patients with locoregionally advanced disease. Future studies are needed to ascertain barriers to care and develop novel targeted pathways to ensure equitable access to high-volume facilities and high-quality oncologic care.

中文翻译：

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前往高容量中心和癌症食管切除术后的生存率


重要性正在进行的努力鼓励食管腺癌治疗向高容量中心 （HVC） 区域化。然而，这种集中化与患者旅行负担的增加和术后护理连续性降低有关。目的确定与在低容量中心 （LVC） 接受当地护理相比，前往 HVC 接受食管切除术是否与更高的总生存期有关。设计、设置和参与者这项队列研究考虑了 2010-2021 年国家癌症数据库中所有被诊断为 I 至 III 期食管腺癌的患者的数据。根据接受护理的旅行距离和治疗医院的年食管切除术量对患者进行分层：旅行-HVC 队列包括在旅行负担前 25 个百分位数的患者，他们在容量最高的四分位数的中心接受护理，本地 LVC 队列代表那些在旅行负担最低的第 25 个百分位数的人在容量最低的四分位数的中心接受治疗。分析了 2023 年 7 月至 2024 年 1 月的数据。主要结局和措施主要终点是 1 年和 5 年的总生存期。次要终点包括围手术期结局和与旅行接受护理相关的因素。结果在 17 970 例患者中，2342 例 （13%） 为旅行型 HVC 队列，1969 例 （11%） 为局部型 LVC 队列。中位 （IQR） 年龄为 65 （58-71） 岁;3748 例 （87%） 为男性，563 例 （13%） 为女性。经过风险调整后，以当地 LVC 的护理为参考，前往 HVC 与 1 年 （死亡率风险比 [HR]，0.69;95% CI，0.58-0.83） 和 5 年 （HR，0.80;95% CI，0.70-0.90） 的生存率较高相关。 按分期分层，前往 HVC 与 I 期疾病的可比结局相关，但 III 期死亡率降低 （1 年 HR，0.72;95% CI，0.60-0.87;5 年 HR，0.83;95% CI，0.74-0.93）。此外，前往 HVC 与更大的淋巴结收获 （β，5.08 个淋巴结;95% CI，3.78-6.37） 和切缘阴性切除的可能性 （校正比值比，1.83;95% CI，1.29-2.60） 相关。结论和相关性与在 LVC 当地接受治疗相比，前往 HVC 进行食管切除术与 1 年和 5 年生存率的提高相关，尤其是在局部区域晚期疾病患者中。需要未来的研究来确定护理的障碍并开发新的靶向途径，以确保公平获得高容量设施和高质量的肿瘤护理。