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Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden
Linköping University, Department of Clinical and Experimental Medicine, Urology. Linköping University, Faculty of Health Sciences.
Sahlgrens University Hospital, Sweden .
Lund University, Sweden .
Umeå University, Sweden .
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2013 (English)In: SCANDINAVIAN JOURNAL OF UROLOGY, ISSN 2168-1805, Vol. 47, no 6, 483-490 p.Article in journal (Refereed) Published
Abstract [en]

Objective. This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods. All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with greater than= 10 cystectomies/year and a low-volume hospital (LVH) as one with less than10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results. Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and median follow-up 47 months. Of the 610 (54%) HVH patients, 68 (11%) were pT0, 123 (20%) less thanpT2, 177 (29%) pT2, 242 (40%) greater thanpT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases. Conclusions. In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival.

Place, publisher, year, edition, pages
Informa Healthcare , 2013. Vol. 47, no 6, 483-490 p.
Keyword [en]
distant metastasis; hospital volume; local recurrence; microscopic radical resection; organ-confined disease; radical cystectomy
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-103728DOI: 10.3109/21681805.2013.787118ISI: 000328899000007OAI: diva2:690686
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2014-01-24

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Jahnson, Staffan
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UrologyFaculty of Health SciencesDivision of Clinical SciencesDepartment of Urology in Östergötland
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