Objective

To evaluate national trends and the effect of surgical volume on perioperative mortality and overall survival (OS)in patients undergoing radical cystectomy (RC) for muscle invasive bladder cancer (MIBC).

Methods

We investigated the National Cancer Database to identify patients with localized MIBC (cT2a-T4, M0) who underwent RC from 2004 to 2014. Demographics, 30- and 90-day mortality rates, as well as OS were analyzed. Hospitals were stratified into low-, medium-, and high-volume centers according to median number of RCs performed per year. Multivariate logistic regression models were fitted to identify independent predictors of perioperative mortality. Kaplan-Meier survival curves were generated to evaluate OS. Cox proportional hazard modeling was performed to identify independent predictors of OS.

Results

A total of 24,763 patients with localized MIBC who underwent RC from 2004 to 2014 were included in the study. Overall, most (70.85%) RCs occurred at low-volume hospitals, whereas only 15.83% were performed at high-volume hospitals. Thirty-day mortality rates were 2.87%, 2.19%, and 1.83% (P < .01); and 90-day mortality rates were 8.25%, 6.9%, and 5.9% (P < .01) at low-, medium-, and high-volume hospitals, respectively. Multivariate analyses identified RC volume as an independent predictor of 30- and 90-day mortality. RC in high-volume hospitals was associated with a 35% risk reduction in 30-day mortality (odds ratio 0.65, 95% confidence interval [CI] 0.49-0.85; P < .01), and a 26% risk reduction in 90-day mortality (0.74, 95% CI, 0.63-0.87; P < .01).

Conclusions

Treatment at high-volume centers offers improved outcomes and OS benefit. However, in the United States, only 16% of RCs are performed in high-volume hospitals.

中文翻译：

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根治性膀胱切除术区域化对肌肉浸润性膀胱癌患者生存结果的全国趋势和影响。

目标

评估全国趋势以及手术量对肌肉浸润性膀胱癌 (MIBC) 根治性膀胱切除术 (RC) 患者围手术期死亡率和总生存期 (OS) 的影响。

方法

我们调查了国家癌症数据库，以确定 2004 年至 2014 年期间接受 RC 的局部 MIBC（cT2a-T4，M0）患者。分析了人口统计学、30 天和 90 天死亡率以及 OS。根据每年执行的 RC 的中位数，医院被分为低、中和高容量中心。拟合多变量逻辑回归模型以确定围手术期死亡率的独立预测因素。生成 Kaplan-Meier 生存曲线以评估 OS。进行 Cox 比例风险模型以确定 OS 的独立预测因子。

结果

该研究共纳入了 24,763 名在 2004 年至 2014 年期间接受 RC 的局部 MIBC 患者。总体而言，大多数 (70.85%) RC 发生在小医院，而只有 15.83% 是在大医院进行的。30 天死亡率分别为 2.87%、2.19% 和 1.83% ( P  < .01)； 低、中和高容量医院的90 天死亡率和 90 天死亡率分别为 8.25%、6.9% 和 5.9% ( P < .01)。多变量分析将 RC 体积确定为 30 天和 90 天死亡率的独立预测因子。大医院的 RC 与 30 天死亡率降低 35% 的风险相关（优势比 0.65，95% 置信区间 [CI] 0.49-0.85；P  < .01），90天死亡率降低 26%天死亡率 (0.74, 95% CI, 0.63-0.87; P < .01)。

结论

在高容量中心进行治疗可提供更好的结果和 OS 益处。然而，在美国，只有 16% 的 RC 是在大容量医院进行的。