University hospital status and gastric cancer mortality: A population-based nationwide study in Finland

Gastric cancer remains a significant global health issue with increasing mortality, despite advancements in treatment. Previous studies have suggested that surgery performed at university hospitals may influence surgical outcomes and mortality rates, but evidence of its effect on gastric cancer remains limited. This study aimed to investigate whether gastrectomy performed at university hospitals reduces short-term and long-term mortality rates in Finland.

This nationwide population-based retrospective cohort study analyzed patients with gastric cancer who underwent gastrectomy in Finland from 1987 to 2016, using data from the Finnish Cancer Registry, Finnish Patient Registry, and Finnish Death Registry. The study compared 5-year, 30-day, and 90-day all-cause mortality rates between patients treated at university hospitals and those treated at nonuniversity hospitals, with adjustments for confounders using multivariate Cox regression models.

Of 10,455 patients who underwent gastrectomy in Finland between 1987 and 2016, most were treated in nonuniversity hospitals. Patients who underwent gastrectomy at university hospitals were generally younger and had more comorbidities and more advanced cancer stages. Of note, 30-day, 90-day, and 5-year survival rates were higher in university hospitals than in nonuniversity hospitals, although the differences in 90-day and 5-year survival rates were not statistically significant in more recent years.

Our findings suggest that gastrectomy performed at university hospitals in Finland is associated with lower short-term and long-term mortality rates than gastrectomy performed at nonuniversity hospitals. In addition, our findings support the potential benefits of centralizing gastric cancer surgical procedures at university hospitals. However, further research is needed to explore the underlying reasons.