You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2017MP54-10 ANALYSIS OF QUALITY INDICATORS FOR CYSTECTOMY USING DATA FROM THE NATIONAL CANCER DATABASE Andrew Bachman, Alexander Parker, Marshall Shaw, Brian Cross, Kelly Stratton, Michael Cookson, and Sanjay Patel Andrew BachmanAndrew Bachman More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Marshall ShawMarshall Shaw More articles by this author , Brian CrossBrian Cross More articles by this author , Kelly StrattonKelly Stratton More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1682AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To examine the national patterns of quality indicators for cystectomy and identify facility characteristics predictive of high quality care. METHODS We performed a retrospective cohort study of patients who underwent cystectomy for cT2-cT4, N0 bladder cancer between 2008 and 2013 using the National Cancer Database. Quality indicators were defined as 1) surgical margin status, 2) lymph node yield, and 3) receipt of neoadjuvant chemotherapy. Univariate analysis and multivariate analysis was used to assess the relationship between academic facility type and annual cystectomy volume and quality indicators while controlling for demographic and pathologic characteristics. RESULTS A total of 12,083 patients met our inclusion criteria. On multivariate analysis, while controlling for demographic and pathologic characteristics, treatment at academic facilities was associated with higher rates of negative margins (OR: 0.80; 95%CI: [0.67-0.95], p=0.01), greater lymph node yields (OR: 0.49; [0.44-0.55], p<0.001), and higher rates of neoadjuvant chemotherapy(OR: 0.73; [0.64-0.55], p<0.001). High volume facilities (>24 cystectomies/year) were associated with greater lymph node yields (OR: 2.69; [2.08-3.47], p<0.001), but not significantly associated with increased neoadjuvant chemotherapy use. Intermediate volume centers (12-24 cystectomies/year) were associated with increased neoadjuvant chemotherapy use (OR: 1.60; [1.36-1.88], p<0.001). CONCLUSIONS At a national level, high quality indicators of cystectomy (negative surgical margin, adequate lymph node yields, and receipt of neoadjuvant chemotherapy) were more likely to occur at academic facilities. High volume centers were associated with higher lymph node yields. Such data support the regionalization of cystectomy care to these centers. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e725-e726 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrew Bachman More articles by this author Alexander Parker More articles by this author Marshall Shaw More articles by this author Brian Cross More articles by this author Kelly Stratton More articles by this author Michael Cookson More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2017MP76-09 PREDICTORS OF METASTASIS AT TIME OF DIAGNOSIS AND OVERALL SURVIVAL IN METASTATIC TESTICULAR CANCER Marshall Shaw, Andrew Bachman, Alexander Parker, Brian Cross, Kelly Stratton, Michael Cookson, and Sanjay Patel Marshall ShawMarshall Shaw More articles by this author , Andrew BachmanAndrew Bachman More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Brian CrossBrian Cross More articles by this author , Kelly StrattonKelly Stratton More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Few large series in the literature examine predictors of metastatic disease at time of testicular cancer diagnosis. We performed an analysis of the National Cancer Database (NCDB) to examine predictors of metastatic disease at the time of diagnosis and overall survival (OS) based on site of metastatic disease. METHODS Utilizing the NCDB, 44,354 patients were identified with data available for metastatic disease at time of diagnosis and tumor histology. Metastases were stratified as either absent, lymph node only, lung, brain, liver or bone metastases. Demographic characteristics, socioeconomic indicators and tumor histology were compared using the chi-squared test. Univariate survival analysis was performed using the Kaplan Meier method. Multivariate survival analysis was performed using cox proportional hazard model. RESULTS Mean age of diagnosis was 35 and mean follow-up was 53 months. On univariate analysis decreased age at diagnosis (p<0.001), non-white race (p=0.002), uninsured status (p=<0.001), <$38,000 annual income (p=<0.001), distance from treating hospital (p<0.001), and pure choriocarcinoma histology (166/202, 82%, p<0.001) were associated with metastases at time of diagnosis. 3,504 (7.9%) patients had metastatic disease at diagnosis. Kaplan Meier survival analysis showed significant differences in OS between metastatic sites at presentation, with 5 yr OS of 87% for lymph node only metastases compared to 48% OS in those with brain metastases (p<0.001). On multivariate analysis while controlling for age, race, insurance status, income, comorbidities, histology, receipt of chemotherapy, and primary tumor size, metastases to any site were associated with worsened survival compared to no metastases (referent): metastasis to lymph nodes (3.4, 95% CI: 2.70-4.50, p<0.001), lung (4.48, 95% CI: 3.69-5.43, p<0.001), liver (10.32, 95% CI: 6.78-15.7), bone (12.99, 95% CI: 7.93-21.29) and brain (14.4, 95% CI: 9.53-21.89). Private insurance status (0.48, 95% CI: 0.40-0.56, p<0.001) and income >$63,000 (0.72, 95% CI: 0.60-0.87, p=0.001) were favorable predictors of OS. CONCLUSIONS There are significant differences in OS dependent on site of metastases at time of testicular cancer diagnosis. Several sociodemographic factors likely contribute to likelihood of metastases at presentation as well. Further prospective studies are warranted to better characterize the impact of sociodemographic factors on metastases at presentation and to improve access to care in high-risk populations. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1016 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marshall Shaw More articles by this author Andrew Bachman More articles by this author Alexander Parker More articles by this author Brian Cross More articles by this author Kelly Stratton More articles by this author Michael Cookson More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE To examine temporal national trends of operative approach for cystectomy and identify demographic or clinical predictive factors that influence choice of approach.METHODS We performed a retrospective cohort study of patients who underwent cystectomy for bladder cancer between 2010 and 2013 using the National Cancer Database. Approach was stratified by open vs minimally invasive (robotic or laparoscopic). Univariate Pearson chi-square and multivariate logistic regression analysis were used to assess the relationships between demographic and hospital factors and the receipt of minimally invasive or open surgical approach.RESULTS A total of 9439 patients met our inclusion criteria, of which 34.1% received a minimally invasive approach (MIA). Frequency of MIA increased from 26.3% in 2010 to 39.4% in 2013 (P < .0001). Univariate analysis identified statistically significant associations between year of diagnosis, sex, age, race, clinical T stage, insurance status, income, education, distance from hospital, facility type, geographic location, and facility cystectomy volume, and the choice of approach (all P < .01). On multivariate analysis, independent predictors of MIA included increasing year of diagnosis, male gender, lower clinical T stage, private insurance vs Medicaid, nonacademic vs academic program, northeastern geographic region, receipt of neoadjuvant chemotherapy, and lower cystectomy volume.CONCLUSION Utilization of MIA for cystectomy has increased nationally over the last several years likely due to increased surgeon familiarity with robotic laparoscopic pelvic surgery. Factors associated with MIA included male sex, locally confined disease, receipt of neoadjuvant chemotherapy, lower cystectomy volume centers, and nonacademic centers. (C) 2017 Elsevier Inc.