To evaluate the relationship between hospital volume and intermediate and long-term patient survival for patients undergoing nephrectomy for renal cell carcinoma (RCC).
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.
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.
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.
BJU international. 2019 Jun 17 [Epub ahead of print]
Ray C J Hsu, Matthew Barclay, Molly A Loughran, Georgios Lyratzopoulos, Vincent J Gnanapragasam, James N Armitage
Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge Biomedical Campus. Hills Road, Cambridge, UK, CB2 0QQ., The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK., Transforming Cancer Services Team, National Health Service, Skipton House, London, UK, SE1 6LH., Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK, CB2 0QQ.