PURPOSE: Given that the urologist has a major influence on outcomes following radical cystectomy (RC), it is of interest to patients, trainees, urologists and administrators to understand the provider characteristics associated with favourable outcomes.
Our objective was to assess associations between various surgeon characteristics and long-term oncologic outcomes for patients undergoing RC for bladder cancer (BC).
MATERIALS AND METHODS: A retrospective cohort undergoing RC for muscle-invasive or non-muscle-invasive BC at University Health Network (Toronto) was assembled. The characteristics studied include years of experience in independent practice, surgical RC volume, subspecialized focus in BC, and uro-oncology fellowship training. Overall survival (OS), BC-specific (BCSS), and recurrence-free survival (RFS) were the outcomes. Kaplan-Meier analyses and multivariable 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 follow up= 57 months). BC-focused and uro-oncology fellowship-trained urologists performed more extensive lymphadenectomies and more often performed continent diversions, but there was no difference in use of neo-adjuvant chemotherapy. In Kaplan-Meier and univariate Cox analyses, both subspecialized BC-focus and uro-oncology fellowship were associated with improved survival outcomes. However, in multivariable Cox models, only subspecialized BC-focus was independently associated with improved OS (HR=0.68, 95%CI=0.55-0.85, p< 0.001), BCSS (HR=0.63, 95%CI=0.41-0.96, p=0.032) and RFS (HR=0.63, 95%CI=0.42-0.95, p=0.027).
CONCLUSIONS: While RC volume, experience, and uro-oncology fellowship are all likely important, we found that subspecialized focus in BC was independently associated with improved long-term oncologic outcomes. Our data supports disease site differentiation among uro-oncologists in large institutions.
Written by:
Bhindi B, Yu J, Kuk C, Sridhar SS, Hamilton RJ, Finelli A, Jewett MA, Evans A, Fleshner NE, Zlotta AR, Kulkarni GS. Are you the author?
Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Department of Medical Oncology, University Health Network, University of Toronto, Toronto, Canada; Department of Pathology, University Health Network, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, University of Toronto, Toronto, Canada.
Reference: J Urol. 2014 Mar 1. pii: S0022-5347(14)00351-6.
doi: 10.1016/j.juro.2014.02.093
PubMed Abstract
PMID: 24594406
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