Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
Eur Urol Oncol. 2019 May;2(3):265-273. doi: 10.1016/j.euo.2018.10.006. Epub 2018 Nov 5.
The centralization of cancer care is associated with better clinical outcomes and may be a method for optimizing value-based health care systems.
To systematically review the literature regarding the impact of centralization of care on clinical outcomes for genitourinary malignancies.
A systematic review was conducted using Ovid and MEDLINE to identify studies between 1970 and 2018 reporting on the centralization of care for genitourinary malignancies. Prospective and retrospective studies were screened.
There were no published randomized control trials (RCTs) on the centralization of care for genitourinary malignancies. Twenty-two retrospective studies met inclusion criteria. Centralization of radical cystectomy was the most studied. Care for bladder cancer, prostate cancer, penile cancer, testicular cancer, and renal cancer was reportedly associated with better morbidity and survival outcomes for patients treated at high-volume centers. However, evidence of better outcomes for centralization of care remains limited for penile, renal, and testicular cancers owing to the paucity of data and/or the lower incidence of these genitourinary malignancies.
Care for genitourinary malignancies by high-volume providers was associated with greater utilization of cancer surgery, lower morbidity, and better survival outcomes. Centralization of care was most appropriate for complex procedures such as radical cystectomy when interpreted in the context of survival outcomes. Further research is needed to address the impact of centralizing care for all urologic malignancies with consideration of the associated costs and patient-reported measures, including quality of life and patient experience.
We explored the evidence for moving major operations into larger centers. We focused on surgery for cancers of the bladder, prostate, testicle, penis, and kidney, and found that larger-volume hospitals had better survival outcomes and fewer complications when compared to smaller hospitals. The difference may be greatest for complex major surgeries such as radical cystectomy.
癌症治疗的集中化与更好的临床结果相关，并且可能是优化基于价值的医疗保健系统的一种方法。
系统回顾文献，评估治疗泌尿生殖系统恶性肿瘤的集中化治疗对临床结果的影响。
通过 Ovid 和 MEDLINE 进行系统回顾，以确定自 1970 年至 2018 年报道泌尿生殖系统恶性肿瘤治疗集中化的研究。筛选前瞻性和回顾性研究。
目前尚无关于泌尿生殖系统恶性肿瘤治疗集中化的随机对照试验（RCT）。22 项回顾性研究符合纳入标准。根治性膀胱切除术的集中化治疗是研究最多的。对于在高容量中心接受治疗的患者，膀胱癌、前列腺癌、阴茎癌、睾丸癌和肾癌的治疗与更好的发病率和生存结果相关。然而，由于数据缺乏和/或这些泌尿生殖系统恶性肿瘤的发病率较低，对于阴茎癌、肾癌和睾丸癌集中化治疗的获益仍存在限制。
高容量提供者治疗泌尿生殖系统恶性肿瘤与更多癌症手术的应用、更低的发病率和更好的生存结果相关。集中化治疗最适合于根治性膀胱切除术等复杂手术，这需要结合生存结果进行解释。需要进一步研究来解决集中化治疗所有泌尿外科恶性肿瘤的影响，同时考虑相关成本和患者报告的措施，包括生活质量和患者体验。
我们探讨了将主要手术转移到更大中心的证据。我们专注于膀胱癌、前列腺癌、睾丸癌、阴茎癌和肾癌的手术治疗，发现与小医院相比，大医院的生存率更高，并发症更少。对于复杂的主要手术，如根治性膀胱切除术，这种差异可能最大。
