INTRODUCTION: : We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes. METHODS: : A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes. RESULTS: : There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43). CONCLUSION: : There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.
INTRODUCTION: : We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes. METHODS: : A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes. RESULTS: : There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43). CONCLUSION: : There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.
Authors: Thomas J Walton; Giacomo Novara; Kazumasa Matsumoto; Wassim Kassouf; Hans-Martin Fritsche; Walter Artibani; Patrick J Bastian; Juan I Martínez-Salamanca; Christian Seitz; Stephen A Thomas; Vincenzo Ficarra; Maximilian Burger; Stefan Tritschler; Pierre I Karakiewicz; Shahrokh F Shariat Journal: BJU Int Date: 2010-11-15 Impact factor: 5.588
Authors: Yves Fradet; Armen Aprikian; George Dranitsaris; Robert Siemens; John Tsihlias; Neil Fleshner Journal: Can J Urol Date: 2006-06 Impact factor: 1.344
Authors: Mehdi Mokhtar Ariane; Pierre Colin; Adil Ouzzane; Geraldine Pignot; Marie Audouin; Jean-Nicolas Cornu; Baptiste Albouy; Julien Guillotreau; Yann Neuzillet; Sébastien Crouzet; Sophie Hurel; Frederic Arroua; Pierre Bigot; Charles Marchand; Pierre Olivier Fais; Alexandre de la Taille; Fabien Saint; Emmanuel Ravier; Alexandre Matte; Laurent Guy; Franck Bruyère; Morgan Rouprêt Journal: Ann Surg Oncol Date: 2011-06-21 Impact factor: 5.344
Authors: M Rouprêt; R Zigeuner; J Palou; A Boehle; E Kaasinen; R Sylvester; M Babjuk; W Oosterlinck Journal: Actas Urol Esp Date: 2011-10-29 Impact factor: 0.994
Authors: Adrian S Fairey; Wassim Kassouf; Eric Estey; Simon Tanguay; Ricardo Rendon; David Bell; Jonathan Izawa; Joseph Chin; Anil Kapoor; Edward Matsumoto; Peter Black; Alan So; Jean-Baptiste Lattouf; Fred Saad; Darrel Drachenberg; Ilias Cagiannos; Louis Lacombe; Yves Fradet; Niels-Erik B Jacobsen Journal: BJU Int Date: 2012-11-13 Impact factor: 5.588
Authors: Debasish Sundi; Robert S Svatek; Vitaly Margulis; Christopher G Wood; Surena F Matin; Colin P Dinney; Ashish M Kamat Journal: Urol Oncol Date: 2010-09-25 Impact factor: 3.498
Authors: H Scher; R Bahnson; S Cohen; M Eisenberger; H Herr; J Kozlowski; P Lange; J Montie; A Pollack; D Raghaven; J Richie; W Shipley Journal: Oncology (Williston Park) Date: 1998-07 Impact factor: 2.990
Authors: Umberto Capitanio; Shahrokh F Shariat; Hendrik Isbarn; Alon Weizer; Mesut Remzi; Marco Roscigno; Eiji Kikuchi; Jay D Raman; Christian Bolenz; Karim Bensalah; Theresa M Koppie; Wassim Kassouf; Mario I Fernández; Philipp Ströbel; Jeffrey Wheat; Richard Zigeuner; Cord Langner; Matthias Waldert; Mototsugu Oya; Charles C Guo; Casey Ng; Francesco Montorsi; Christopher G Wood; Vitaly Margulis; Pierre I Karakiewicz Journal: Eur Urol Date: 2009-04-03 Impact factor: 20.096
Authors: Matthias Waldert; Mesut Remzi; Hans Christoph Klingler; Lukas Mueller; Michael Marberger Journal: BJU Int Date: 2008-08-14 Impact factor: 5.588