Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy

Afsaneh Barzi, Primo N Lara, Denice Tsao-Wei, Dongyun Yang, Inderbir S. Gill, Siamak Daneshmand, Eric A. Klein, Jacek K. Pinski, David F. Penson, David I. Quinn, Sarmad Sadeghi

Research output: Contribution to journalArticle

Abstract

Background: Several studies have investigated the relationship between experience measured by caseload and oncological outcomes, economics, and access to care for prostate cancer care. Oncological outcomes have been limited to biochemical failure after radical prostatectomy. Questions remain regarding the more definitive measures of outcomes and their relationship with caseload. Methods: The National Cancer Database was used to investigate the outcomes of radical prostatectomy in the United States. With overall survival (OS) as the primary outcome, the relationship between the facility annual caseload (FAC) for all prostate cancer encounters and the facility annual surgical caseload (FASC) for those requiring radical prostatectomy was examined with a Cox proportional hazards model. Four volume groups were defined by caseload: <50th percentile (volume group 1 [VG1]), 50th to 74th percentiles (volume group 2 [VG2]), 75th to 89th percentiles (volume group 3 [VG3]), and ≥90th percentile (volume group 4 [VG4]). By FAC/FASC, 11%/8%, 17%/18%, 25%/26%, and 47%/49% of patients were treated in VG1 through VG4, respectively. Results: Between 2004 and 2014, 488,389 patients underwent radical prostatectomy. At a median follow-up of 60.75 months, the median OS was not reached. There was a significant OS benefit as the caseload increased. For FAC, the adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months (hazard ratio [HR], 1.30; 95% CI, 1.23-1.36; P <.0001). For FASC, this was 11.3 months (HR, 1.25; 95% CI, 1.192-1.321; P <.0001). Conclusions: There is a statistically significant OS advantage from performing radical prostatectomy at a facility with a high annual caseload. Caseload measured by all prostate cancer encounters is a better predictor of favorable outcomes than the number of surgeries performed at a facility. Lay Summary: An in-depth analysis of 488,389 cases of radical prostatectomy performed in more than 1000 facilities over a 10-year period showed better survival when surgery was performed in facilities with more experience and greater caseload. A survival difference of up to 13 months was observed when comparing patients treated at less experienced versus more experienced centers. Experience across all stages of prostate cancer was a stronger predictor of survival outcome than just the number of surgeries performed.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2019

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Prostatectomy
Prostatic Neoplasms
Survival
Proportional Hazards Models
Survival Rate
Economics
Outcome Assessment (Health Care)
Databases
Neoplasms

Keywords

  • facility caseload
  • oncologic outcomes
  • overall survival
  • radical prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy. / Barzi, Afsaneh; Lara, Primo N; Tsao-Wei, Denice; Yang, Dongyun; Gill, Inderbir S.; Daneshmand, Siamak; Klein, Eric A.; Pinski, Jacek K.; Penson, David F.; Quinn, David I.; Sadeghi, Sarmad.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Barzi, A, Lara, PN, Tsao-Wei, D, Yang, D, Gill, IS, Daneshmand, S, Klein, EA, Pinski, JK, Penson, DF, Quinn, DI & Sadeghi, S 2019, 'Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy', Cancer. https://doi.org/10.1002/cncr.32290
Barzi, Afsaneh ; Lara, Primo N ; Tsao-Wei, Denice ; Yang, Dongyun ; Gill, Inderbir S. ; Daneshmand, Siamak ; Klein, Eric A. ; Pinski, Jacek K. ; Penson, David F. ; Quinn, David I. ; Sadeghi, Sarmad. / Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy. In: Cancer. 2019.
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title = "Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy",
abstract = "Background: Several studies have investigated the relationship between experience measured by caseload and oncological outcomes, economics, and access to care for prostate cancer care. Oncological outcomes have been limited to biochemical failure after radical prostatectomy. Questions remain regarding the more definitive measures of outcomes and their relationship with caseload. Methods: The National Cancer Database was used to investigate the outcomes of radical prostatectomy in the United States. With overall survival (OS) as the primary outcome, the relationship between the facility annual caseload (FAC) for all prostate cancer encounters and the facility annual surgical caseload (FASC) for those requiring radical prostatectomy was examined with a Cox proportional hazards model. Four volume groups were defined by caseload: <50th percentile (volume group 1 [VG1]), 50th to 74th percentiles (volume group 2 [VG2]), 75th to 89th percentiles (volume group 3 [VG3]), and ≥90th percentile (volume group 4 [VG4]). By FAC/FASC, 11{\%}/8{\%}, 17{\%}/18{\%}, 25{\%}/26{\%}, and 47{\%}/49{\%} of patients were treated in VG1 through VG4, respectively. Results: Between 2004 and 2014, 488,389 patients underwent radical prostatectomy. At a median follow-up of 60.75 months, the median OS was not reached. There was a significant OS benefit as the caseload increased. For FAC, the adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months (hazard ratio [HR], 1.30; 95{\%} CI, 1.23-1.36; P <.0001). For FASC, this was 11.3 months (HR, 1.25; 95{\%} CI, 1.192-1.321; P <.0001). Conclusions: There is a statistically significant OS advantage from performing radical prostatectomy at a facility with a high annual caseload. Caseload measured by all prostate cancer encounters is a better predictor of favorable outcomes than the number of surgeries performed at a facility. Lay Summary: An in-depth analysis of 488,389 cases of radical prostatectomy performed in more than 1000 facilities over a 10-year period showed better survival when surgery was performed in facilities with more experience and greater caseload. A survival difference of up to 13 months was observed when comparing patients treated at less experienced versus more experienced centers. Experience across all stages of prostate cancer was a stronger predictor of survival outcome than just the number of surgeries performed.",
keywords = "facility caseload, oncologic outcomes, overall survival, radical prostatectomy",
author = "Afsaneh Barzi and Lara, {Primo N} and Denice Tsao-Wei and Dongyun Yang and Gill, {Inderbir S.} and Siamak Daneshmand and Klein, {Eric A.} and Pinski, {Jacek K.} and Penson, {David F.} and Quinn, {David I.} and Sarmad Sadeghi",
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language = "English (US)",
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T1 - Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy

AU - Barzi, Afsaneh

AU - Lara, Primo N

AU - Tsao-Wei, Denice

AU - Yang, Dongyun

AU - Gill, Inderbir S.

AU - Daneshmand, Siamak

AU - Klein, Eric A.

AU - Pinski, Jacek K.

AU - Penson, David F.

AU - Quinn, David I.

AU - Sadeghi, Sarmad

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Several studies have investigated the relationship between experience measured by caseload and oncological outcomes, economics, and access to care for prostate cancer care. Oncological outcomes have been limited to biochemical failure after radical prostatectomy. Questions remain regarding the more definitive measures of outcomes and their relationship with caseload. Methods: The National Cancer Database was used to investigate the outcomes of radical prostatectomy in the United States. With overall survival (OS) as the primary outcome, the relationship between the facility annual caseload (FAC) for all prostate cancer encounters and the facility annual surgical caseload (FASC) for those requiring radical prostatectomy was examined with a Cox proportional hazards model. Four volume groups were defined by caseload: <50th percentile (volume group 1 [VG1]), 50th to 74th percentiles (volume group 2 [VG2]), 75th to 89th percentiles (volume group 3 [VG3]), and ≥90th percentile (volume group 4 [VG4]). By FAC/FASC, 11%/8%, 17%/18%, 25%/26%, and 47%/49% of patients were treated in VG1 through VG4, respectively. Results: Between 2004 and 2014, 488,389 patients underwent radical prostatectomy. At a median follow-up of 60.75 months, the median OS was not reached. There was a significant OS benefit as the caseload increased. For FAC, the adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months (hazard ratio [HR], 1.30; 95% CI, 1.23-1.36; P <.0001). For FASC, this was 11.3 months (HR, 1.25; 95% CI, 1.192-1.321; P <.0001). Conclusions: There is a statistically significant OS advantage from performing radical prostatectomy at a facility with a high annual caseload. Caseload measured by all prostate cancer encounters is a better predictor of favorable outcomes than the number of surgeries performed at a facility. Lay Summary: An in-depth analysis of 488,389 cases of radical prostatectomy performed in more than 1000 facilities over a 10-year period showed better survival when surgery was performed in facilities with more experience and greater caseload. A survival difference of up to 13 months was observed when comparing patients treated at less experienced versus more experienced centers. Experience across all stages of prostate cancer was a stronger predictor of survival outcome than just the number of surgeries performed.

AB - Background: Several studies have investigated the relationship between experience measured by caseload and oncological outcomes, economics, and access to care for prostate cancer care. Oncological outcomes have been limited to biochemical failure after radical prostatectomy. Questions remain regarding the more definitive measures of outcomes and their relationship with caseload. Methods: The National Cancer Database was used to investigate the outcomes of radical prostatectomy in the United States. With overall survival (OS) as the primary outcome, the relationship between the facility annual caseload (FAC) for all prostate cancer encounters and the facility annual surgical caseload (FASC) for those requiring radical prostatectomy was examined with a Cox proportional hazards model. Four volume groups were defined by caseload: <50th percentile (volume group 1 [VG1]), 50th to 74th percentiles (volume group 2 [VG2]), 75th to 89th percentiles (volume group 3 [VG3]), and ≥90th percentile (volume group 4 [VG4]). By FAC/FASC, 11%/8%, 17%/18%, 25%/26%, and 47%/49% of patients were treated in VG1 through VG4, respectively. Results: Between 2004 and 2014, 488,389 patients underwent radical prostatectomy. At a median follow-up of 60.75 months, the median OS was not reached. There was a significant OS benefit as the caseload increased. For FAC, the adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months (hazard ratio [HR], 1.30; 95% CI, 1.23-1.36; P <.0001). For FASC, this was 11.3 months (HR, 1.25; 95% CI, 1.192-1.321; P <.0001). Conclusions: There is a statistically significant OS advantage from performing radical prostatectomy at a facility with a high annual caseload. Caseload measured by all prostate cancer encounters is a better predictor of favorable outcomes than the number of surgeries performed at a facility. Lay Summary: An in-depth analysis of 488,389 cases of radical prostatectomy performed in more than 1000 facilities over a 10-year period showed better survival when surgery was performed in facilities with more experience and greater caseload. A survival difference of up to 13 months was observed when comparing patients treated at less experienced versus more experienced centers. Experience across all stages of prostate cancer was a stronger predictor of survival outcome than just the number of surgeries performed.

KW - facility caseload

KW - oncologic outcomes

KW - overall survival

KW - radical prostatectomy

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