Impact of hospital nephrectomy volume on intermediate- to long-term survival in renal cell carcinoma

Ray C.J. Hsu*, Matthew Barclay, Molly A. Loughran, Georgios Lyratzopoulos, Vincent J. Gnanapragasam, James N. Armitage

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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 and Methods: Adult patients with RCC treated with nephrectomy between 2000 and 2010 were identified from the English Hospital Episode Statistics database and National Cancer Data Repository. Patients with nodal or metastatic disease were excluded. Hospitals were categorised into low- (LV; <20 cases/year), medium- (20–39 cases/year) and high-volume (HV; ≥40 cases/year), based on annual cases of RCC nephrectomy. Multivariable Cox regression analyses were used to calculate hazard ratios (HRs) for all-cause mortality by hospital volume, adjusting for patient, tumour and surgical characteristics. We assessed conditional survival over three follow-up periods: short (30 days to 1 year), intermediate (1–3 years) and long (3–5 years). We additionally explored whether associations between volume and outcomes varied by tumour stage.

Results: A total of 12 912 patients were included. Patients in HV hospitals had a 34% reduction in mortality risks up to 1 year compared to those in LV hospitals (HR 0.66, 95% confidence interval 0.53–0.83; P < 0.01). Assuming causality, treatment in HV 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: Nephrectomy for RCC in HV hospitals was associated with improved survival for up to 1 year after treatment. Our results contribute new insights regarding the value of nephrectomy centralisation.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalBJU International
Volume125
Issue number1
Early online date15 Jul 2019
DOIs
Publication statusPublished - 3 Jan 2020

Bibliographical note

Funding Information:
This work was supported by Addenbrooke's Charitable Trust, the Royal College of Surgeons of England and The Urology Foundation. Georgios Lyratzopoulos is supported by Cancer Research UK Advanced Clinician Scientist Fellowship award (No. C18081/A18180). Data for this study are based on information collected and quality assured by the Public Health England National Cancer Registration and Analysis Service. Access to the data was facilitated by the Public Health England Office for Data Release.

Funding Information:
This work was supported by Addenbrooke’s Charitable Trust, the Royal College of Surgeons of England and The Urology Foundation. Georgios Lyratzopoulos is supported by Cancer Research UK Advanced Clinician Scientist Fellowship award (No. C18081/A18180). Data for this study are based on information collected and quality assured by the Public Health England National Cancer Registration and Analysis Service. Access to the data was facilitated by the Public Health England Office for Data Release.

Publisher Copyright:
© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd on behalf of BJU International

Keywords

  • #KidneyCancer
  • #kcsm
  • centralisation
  • hospital volume
  • nephrectomy
  • renal cell carcinoma
  • survival

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