کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3860290 1598900 2014 7 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
The Importance of Surgeon Characteristics on Impacting Oncologic Outcomes for Patients Undergoing Radical Cystectomy
ترجمه فارسی عنوان
اهمیت ویژگی های جراح در تأثیر نتایج انکولوژیک بیماران مبتلا به سیستکتومی رادیکال
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیماری‌های کلیوی
چکیده انگلیسی

PurposeGiven that the urologist has a major influence on outcomes of radical cystectomy, it is of interest to patients, trainees, urologists and administrators to understand the provider characteristics associated with favorable outcomes. Therefore, we assessed associations between various surgeon characteristics and long-term oncologic outcomes for patients undergoing radical cystectomy for bladder cancer.Materials and MethodsA retrospective cohort treated with radical cystectomy for muscle invasive or nonmuscle invasive bladder cancer at University Health Network (Toronto) was assembled. The characteristics studied included years of experience in independent practice, surgical radical cystectomy volume, subspecialized focus in bladder cancer and uro-oncology fellowship training. The outcomes were overall survival, bladder cancer specific survival and recurrence-free survival. Kaplan-Meier analyses and multivariate Cox proportional hazards models adjusting for patient, tumor and treatment related parameters were used.ResultsThe final cohort included 410 patients treated by 11 urologists (median followup 57 months). Bladder cancer focused and uro-oncology fellowship trained urologists performed more extensive lymphadenectomies and more often performed continent diversions, but there was no difference in the use of neoadjuvant chemotherapy. In Kaplan-Meier and univariate Cox analyses, subspecialized bladder cancer focus and uro-oncology fellowship were associated with improved survival outcomes. However, in multivariate Cox models only subspecialized bladder cancer focus was independently associated with improved overall survival (HR 0.68, 95% CI 0.55–0.85, p <0.001), bladder cancer specific survival (HR 0.63, 95% CI 0.41–0.96, p = 0.032) and recurrence-free survival (HR 0.63, 95% CI 0.42–0.95, p = 0.027).ConclusionsWhile radical cystectomy volume, experience and uro-oncology fellowship are all likely important, we found that subspecialized focus in bladder cancer was independently associated with improved long-term oncologic outcomes. Our data support disease site differentiation among uro-oncologists at large institutions.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The Journal of Urology - Volume 192, Issue 3, September 2014, Pages 714–720
نویسندگان
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