To assess the potential benefit of centralization of care in penile cancer. Centralization of care in other disease processes standardizes treatment and improves outcomes. Since penile cancer is a rare malignancy with unchanged mortality rates over the last two decades, we hypothesize that there may be a benefit to centralization.
We identified surgeon, patient, and hospital characteristics captured by the National Cancer Data Base (1998-2012) and American Board of Urology case logs (2003-2013) for all penile cancer cases and procedures. Differences in patient demographics, stage of disease, referral patterns, and surgical quality indicators were assessed between academic and non-academic hospitals.
Using case-logs to evaluate the distribution of penile cancer care, we found that only 4. 1% of urologists performed a penile surgery and 1. 5% performed a lymph node dissection. Academic centers treated higher-stage cancers and saw more cases/year than non-academic suggesting informal centralization. Two guideline-based quality indicators demonstrated no difference in use of penile-sparing surgery but a higher likelihood of having a LND performed at an academic center (48. 4% vs. 26. 6%). The total LN-yield was significantly greater at academic centers (18. 5 vs. 12. 5). Regression modeling demonstrated a 2. 29 increased odds of having a LND at an academic center.
Our data provides the first evidence for centralization of penile cancer in the US. At the time of diagnosis, equal number of patients are treated with penile-sparing surgery but there is greater use of LND and higher LN yield at academic center. Ultimately, longer follow-up is necessary to determine if this improves survival of patients with penile cancer.
Urology. 2016 Jan 28 [Epub ahead of print]
Richard S Matulewicz, Andrew S Flum, Irene Helenowski, Borko Jovanovic, Bryan Palis, Karl Y Bilimoria, Joshua J Meeks
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. , Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. , Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. , American College of Surgeons, Chicago, IL, USA. , Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, IL, USA. , Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.