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Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden

Sabir, Emad F. ; Holmang, Sten ; Liedberg, Fredrik LU ; Ljungberg, Borje ; Malmstrom, Per-Uno ; Månsson, Wiking LU ; Wijkstrom, Hans and Jahnson, Staffan (2013) In Scandinavian Journal of Urology 47(6). p.483-490
Abstract
Objective. This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods. All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with >= 10 cystectomies/year and a low-volume hospital (LVH) as one with <10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results. Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and... (More)
Objective. This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods. All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with >= 10 cystectomies/year and a low-volume hospital (LVH) as one with <10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results. Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and median follow-up 47 months. Of the 610 (54%) HVH patients, 68 (11%) were pT0, 123 (20%) <pT2, 177 (29%) pT2, 242 (40%) >pT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases. Conclusions. In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
distant metastasis, hospital volume, local recurrence, microscopic, radical resection, organ-confined disease, radical cystectomy
in
Scandinavian Journal of Urology
volume
47
issue
6
pages
483 - 490
publisher
Taylor & Francis
external identifiers
  • wos:000328899000007
  • scopus:84890458069
  • pmid:23590830
ISSN
2168-1813
DOI
10.3109/21681805.2013.787118
language
English
LU publication?
yes
id
b3f30e34-7279-4abb-b4b6-334cea56866d (old id 4258978)
date added to LUP
2016-04-01 10:09:37
date last changed
2022-04-12 02:33:56
@article{b3f30e34-7279-4abb-b4b6-334cea56866d,
  abstract     = {{Objective. This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods. All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with &gt;= 10 cystectomies/year and a low-volume hospital (LVH) as one with &lt;10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results. Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and median follow-up 47 months. Of the 610 (54%) HVH patients, 68 (11%) were pT0, 123 (20%) &lt;pT2, 177 (29%) pT2, 242 (40%) &gt;pT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases. Conclusions. In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival.}},
  author       = {{Sabir, Emad F. and Holmang, Sten and Liedberg, Fredrik and Ljungberg, Borje and Malmstrom, Per-Uno and Månsson, Wiking and Wijkstrom, Hans and Jahnson, Staffan}},
  issn         = {{2168-1813}},
  keywords     = {{distant metastasis; hospital volume; local recurrence; microscopic; radical resection; organ-confined disease; radical cystectomy}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{483--490}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden}},
  url          = {{http://dx.doi.org/10.3109/21681805.2013.787118}},
  doi          = {{10.3109/21681805.2013.787118}},
  volume       = {{47}},
  year         = {{2013}},
}