Hsu, RCJ;
Barclay, M;
Loughran, MA;
Lyratzopoulos, G;
Gnanapragasam, VJ;
Armitage, JN;
(2019)
Impact of Hospital Nephrectomy Volume on Intermediate to Long-term Survival in Renal Cell Carcinoma.
BJU International
10.1111/bju.14848.
(In press).
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Abstract
OBJECTIVE: To evaluate the relationship between hospital volume and intermediate and long-term patient survival for patients undergoing nephrectomy for renal cell carcinoma (RCC). PATIENTS & METHODS: Adult RCC patients treated with nephrectomy between 2000 and 2010 were identified from the English Hospital Episode Statistics and National Cancer Data Repository. Patients with nodal or metastatic disease were excluded. Hospitals were categorised into low (<20/yr), medium (20-39/yr) and high (≥40/yr) volume based on annual cases of RCC nephrectomy. Multivariable Cox regressions were used to calculate hazard ratios for all-cause mortality by hospital volume, adjusting for patient, tumour and surgical characteristics. We assessed conditional survival over three follow-up periods: short (30d-1yr), intermediate (1-3yr) and long (3-5yr). We additionally explored whether associations between volume and outcomes varied by tumour stage. RESULTS: 12,912 patients were included. Patients in high volume hospitals had 34% reduction in mortality risks up to one year compared to those in low volume hospitals (HR 0.66, 95% CI 0.53-0.83, p<0.01). Assuming causality, treatment in high volume hospitals was associated with one fewer death in every 71 patients treated. Benefit of nephrectomy centralisation did not change with higher T stage (p=0.17). No significant association between hospital volume and survival was observed beyond the first year. CONCLUSIONS: RCC nephrectomy in high volume hospitals was associated with improved survival for up to one year after treatment. Our results contribute new insights regarding the value of nephrectomy centralisation. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Impact of Hospital Nephrectomy Volume on Intermediate to Long-term Survival in Renal Cell Carcinoma |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/bju.14848 |
| Publisher version: | https://doi.org/10.1111/bju.14848 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10077066 |
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