Could higher hospital spending improve survival in patients with esophageal squamous cell carcinoma? A multicenter...

The hospital spending of patients with esophageal squamous cell carcinoma (ESCC) have been increasing over years, imposing a heavy economic burden on these patients. However, little is known about the association between spending and their overall survival (OS).

We recruited 11,037 ESCC patients who were admitted between August, 2009 and December, 2018 at the Southern Center (Cancer Hospital of Shantou University Medical College), and between January, 2012 to December, 2017 at the Northern Center (Anyang Cancer Hospital). Spending terciles were the exposure measure, and OS was the outcome. OS in terciles 2 and 3 was compared with OS in tercile 1 (the lowest spending tercile) using Cox regression models. Analyses were stratified by TNM stage and study center.

Monthly hospital spending followed an "L-shaped" trend. After a maximum follow-up of 12.52 years, the median survival time was 4.70 years. Higher spending was associated with worse OS in stage 0-II patients (adjusted HR_{tercile 3 vs 1} = 1.55, 95% CI: 1.27-1.89), but with better OS in stage III-IV patients (adjusted HR_{tercile 2 vs 1} = 0.82, 95% CI: 0.74-0.90; adjusted HR_{tercile 3 vs 1} = 0.73, 95% CI: 0.64-0.83). These associations were consistent across both the Southern and Northern Centers.

The findings suggest that early-stage ESCC patients may benefit from more conservative treatment approaches, whereas advanced-stage patients require comprehensive and sufficient treatment.