Fredrik Liedberg1,2, Oskar Hagberg3, Firas Aljabery4, Truls Gårdmark5, Abolfazl Hosseini6, Staffan Jahnson4, Georg Jancke1,2, Tomas Jerlström7, Per-Uno Malmström8, Amir Sherif9, Viveka Ströck10,11, Christel Häggström8,12, Lars Holmberg8,13. 1. Department of Urology, Skåne University Hospital, Malmö, Sweden. 2. Institution of Translational Medicine, Lund University, Malmö, Sweden. 3. Regional Cancer Centre South, Lund, Sweden. 4. Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. 5. Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden. 6. Department of Urology, Karolinska University Hospital, Stockholm, Sweden. 7. Department of Urology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden. 8. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 9. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. 10. Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden. 11. Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 12. Department of Biobank Research, Umeå University, Umeå, Sweden. 13. School of Medicine, King's College London, London, UK.
Abstract
OBJECTIVE: To investigate the association between hospital volume and overall survival (OS), cancer-specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months. PATIENTS AND METHODS: We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1-T3 in Sweden between 1997 and 2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level, and NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually. RESULTS: PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75-1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73-1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90-0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of >3 months after diagnosis. CONCLUSIONS: The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.
OBJECTIVE: To investigate the association between hospital volume and overall survival (OS), cancer-specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months. PATIENTS AND METHODS: We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1-T3 in Sweden between 1997 and 2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level, and NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually. RESULTS: PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75-1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73-1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90-0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of >3 months after diagnosis. CONCLUSIONS: The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.
Authors: Beth Russell; Christel Häggström; Lars Holmberg; Fredrik Liedberg; Truls Gårdmark; Richard T Bryan; Pardeep Kumar; Mieke Van Hemelrijck Journal: BJUI Compass Date: 2021-01-07