Elyn H Wang1, James B Yu2, Cary P Gross3, Robert Abouassaly4, Edward E Cherullo4, Marc C Smaldone5, Nilay D Shah6, Jonathon Kiechle7, Quoc-Dien Trinh8, Maxine Sun9, Simon P Kim10. 1. Yale University, School of Medicine, New Haven, CT. 2. Department of Radiation Oncology, Yale University, New Haven, CT; Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT. 3. Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Internal Medicine, Yale University, New Haven, CT. 4. University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; University Hospital Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland, OH; Seidman Cancer Center, Case Western Comprehensive Medical Center, Cleveland OH. 5. Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA. 6. Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN. 7. University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH. 8. Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 9. University of Montreal, Montreal, Canada. 10. Yale University, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; University Hospital Case Medical Center, Center for Health Care Quality and Outcomes, Cleveland, OH; Seidman Cancer Center, Case Western Comprehensive Medical Center, Cleveland OH. Electronic address: Simon.Kim@UHhospitals.org.
Abstract
OBJECTIVE: To assess whether surgical approach and hospital characteristics independently determine the number of lymph nodes (LNs) removed from prostate cancer patients undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND). METHODS: Using the National Cancer Database, we identified all surgically treated patients diagnosed with pretreatment intermediate- or high-risk prostate cancer from 2010 to 2011. The primary outcome was the number of LNs retrieved at the time of RP. Generalized estimating equations were used to assess for differences in the adjusted number of LNs retrieved after accounting for patient and hospital characteristics and surgical approach. RESULTS: Overall, 35,876 patients were diagnosed with intermediate-risk (61.2%) and high-risk (38.8%) prostate cancer and underwent RP and PLND.On multivariate analysis, open RP and high-volume and academic hospitals were independently associated with greater LN counts compared with robotic-assisted RP and medium or low and community hospitals, respectively (all P <.001). After adjusting for patient and hospital variables, higher adjusted LN counts were observed for open RP compared with robotic-assisted RP (7.1 vs 6.1; P <.001). Adjusted counts were also higher for high-volume hospitals compared with medium- or low-volume hospitals (7.8 vs 5.9; P <.001), and academic compared with community hospitals (7.3 vs 5.6; P <.001). CONCLUSION: Among patients with aggressive prostate cancer treated with RP and PLND, retrieval of LN counts varied by surgical approach and hospital characteristics.
OBJECTIVE: To assess whether surgical approach and hospital characteristics independently determine the number of lymph nodes (LNs) removed from prostate cancerpatients undergoing radical prostatectomy (RP) and pelvic LN dissection (PLND). METHODS: Using the National Cancer Database, we identified all surgically treated patients diagnosed with pretreatment intermediate- or high-risk prostate cancer from 2010 to 2011. The primary outcome was the number of LNs retrieved at the time of RP. Generalized estimating equations were used to assess for differences in the adjusted number of LNs retrieved after accounting for patient and hospital characteristics and surgical approach. RESULTS: Overall, 35,876 patients were diagnosed with intermediate-risk (61.2%) and high-risk (38.8%) prostate cancer and underwent RP and PLND.On multivariate analysis, open RP and high-volume and academic hospitals were independently associated with greater LN counts compared with robotic-assisted RP and medium or low and community hospitals, respectively (all P <.001). After adjusting for patient and hospital variables, higher adjusted LN counts were observed for open RP compared with robotic-assisted RP (7.1 vs 6.1; P <.001). Adjusted counts were also higher for high-volume hospitals compared with medium- or low-volume hospitals (7.8 vs 5.9; P <.001), and academic compared with community hospitals (7.3 vs 5.6; P <.001). CONCLUSION: Among patients with aggressive prostate cancer treated with RP and PLND, retrieval of LN counts varied by surgical approach and hospital characteristics.
Authors: I Henríquez; A Rodríguez-Antolín; J Cassinello; C Gonzalez San Segundo; M Unda; E Gallardo; J López-Torrecilla; A Juarez; J Arranz Journal: Clin Transl Oncol Date: 2017-08-07 Impact factor: 3.405
Authors: Baylee F Bakkila; Daniel Kerekes; Marcella Nunez-Smith; Kevin G Billingsley; Nita Ahuja; Karen Wang; Carol Oladele; Caroline H Johnson; Sajid A Khan Journal: JAMA Netw Open Date: 2022-04-01