Bimal Bhindi1, Julie Yu2, Cynthia Kuk3, Srikala S Sridhar4, Robert J Hamilton5, Antonio Finelli5, Michael A S Jewett5, Andrew Evans6, Neil E Fleshner5, Alexandre R Zlotta7, Girish S Kulkarni8. 1. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: bimal.bhindi@mail.utoronto.ca. 2. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Department of Medical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada. 5. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. 6. Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada. 7. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. 8. Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical and Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
Abstract
PURPOSE: Given that the urologist has a major influence on outcomes of radical cystectomy, it is of interest to patients, trainees, urologists and administrators to understand the provider characteristics associated with favorable outcomes. Therefore, we assessed associations between various surgeon characteristics and long-term oncologic outcomes for patients undergoing radical cystectomy for bladder cancer. MATERIALS AND METHODS: A retrospective cohort treated with radical cystectomy for muscle invasive or nonmuscle invasive bladder cancer at University Health Network (Toronto) was assembled. The characteristics studied included years of experience in independent practice, surgical radical cystectomy volume, subspecialized focus in bladder cancer and uro-oncology fellowship training. The outcomes were overall survival, bladder cancer specific survival and recurrence-free survival. Kaplan-Meier analyses and multivariate Cox proportional hazards models adjusting for patient, tumor and treatment related parameters were used. RESULTS: The final cohort included 410 patients treated by 11 urologists (median followup 57 months). Bladder cancer focused and uro-oncology fellowship trained urologists performed more extensive lymphadenectomies and more often performed continent diversions, but there was no difference in the use of neoadjuvant chemotherapy. In Kaplan-Meier and univariate Cox analyses, subspecialized bladder cancer focus and uro-oncology fellowship were associated with improved survival outcomes. However, in multivariate Cox models only subspecialized bladder cancer focus was independently associated with improved overall survival (HR 0.68, 95% CI 0.55-0.85, p <0.001), bladder cancer specific survival (HR 0.63, 95% CI 0.41-0.96, p = 0.032) and recurrence-free survival (HR 0.63, 95% CI 0.42-0.95, p = 0.027). CONCLUSIONS: While radical cystectomy volume, experience and uro-oncology fellowship are all likely important, we found that subspecialized focus in bladder cancer was independently associated with improved long-term oncologic outcomes. Our data support disease site differentiation among uro-oncologists at large institutions.
PURPOSE: Given that the urologist has a major influence on outcomes of radical cystectomy, it is of interest to patients, trainees, urologists and administrators to understand the provider characteristics associated with favorable outcomes. Therefore, we assessed associations between various surgeon characteristics and long-term oncologic outcomes for patients undergoing radical cystectomy for bladder cancer. MATERIALS AND METHODS: A retrospective cohort treated with radical cystectomy for muscle invasive or nonmuscle invasive bladder cancer at University Health Network (Toronto) was assembled. The characteristics studied included years of experience in independent practice, surgical radical cystectomy volume, subspecialized focus in bladder cancer and uro-oncology fellowship training. The outcomes were overall survival, bladder cancer specific survival and recurrence-free survival. Kaplan-Meier analyses and multivariate Cox proportional hazards models adjusting for patient, tumor and treatment related parameters were used. RESULTS: The final cohort included 410 patients treated by 11 urologists (median followup 57 months). Bladder cancer focused and uro-oncology fellowship trained urologists performed more extensive lymphadenectomies and more often performed continent diversions, but there was no difference in the use of neoadjuvant chemotherapy. In Kaplan-Meier and univariate Cox analyses, subspecialized bladder cancer focus and uro-oncology fellowship were associated with improved survival outcomes. However, in multivariate Cox models only subspecialized bladder cancer focus was independently associated with improved overall survival (HR 0.68, 95% CI 0.55-0.85, p <0.001), bladder cancer specific survival (HR 0.63, 95% CI 0.41-0.96, p = 0.032) and recurrence-free survival (HR 0.63, 95% CI 0.42-0.95, p = 0.027). CONCLUSIONS: While radical cystectomy volume, experience and uro-oncology fellowship are all likely important, we found that subspecialized focus in bladder cancer was independently associated with improved long-term oncologic outcomes. Our data support disease site differentiation among uro-oncologists at large institutions.
Authors: Hak J Lee; Christopher V Barback; Carl K Hoh; Zhengtao Qin; Kareem Kader; David J Hall; David R Vera; Christopher J Kane Journal: J Nucl Med Date: 2017-02-02 Impact factor: 10.057
Authors: Wassim Kassouf; Armen Aprikian; Fred Saad; Rodney H Breau; Girish Kulkarni; David M Guttman; Ken Bagshaw; Jonathan Izawa; Libni Eapen; Adrian Fairey; Alan So; Scott North; Ricardo Rendon; Srikala S Sridhar; Fadi Brimo; Peter Chung; Darrel Drachenberg; Yves Fradet; Niels Jacobsen; Chris Morash; Bobby Shayegan; Geoffrey Gotto; Alex Zlotta; Neil Fleshner; D Robert Siemens; Peter C Black Journal: Can Urol Assoc J Date: 2018-03-19 Impact factor: 1.862
Authors: Wassim Kassouf; Armen Aprikian; Peter Black; Girish Kulkarni; Jonathan Izawa; Libni Eapen; Adrian Fairey; Alan So; Scott North; Ricardo Rendon; Srikala S Sridhar; Tarik Alam; Fadi Brimo; Normand Blais; Chris Booth; Joseph Chin; Peter Chung; Darrel Drachenberg; Yves Fradet; Michael Jewett; Ron Moore; Chris Morash; Bobby Shayegan; Geoffrey Gotto; Neil Fleshner; Fred Saad; D Robert Siemens Journal: Can Urol Assoc J Date: 2016-02-08 Impact factor: 1.862
Authors: Bimal Bhindi; Thomas Hermanns; Yanliang Wei; Julie Yu; Patrick O Richard; Marian S Wettstein; Arnoud Templeton; Kathy Li; Srikala S Sridhar; Michael A S Jewett; Neil E Fleshner; Alexandre R Zlotta; Girish S Kulkarni Journal: Br J Cancer Date: 2015-12-10 Impact factor: 7.640