Cacciamani Giovanni E, Barzi Afsaneh, Eppler Michael B, Lara Primo N, Pan Chong-Xian, Bhanvadia Sumeet K, Gill Parkash, Aron Monish, Gill Inderbir, Sadeghi Sarmad
Institute of Urology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA.
City of Hope Comprehensive Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA 91010, USA.
Cancers (Basel). 2022 Dec 3;14(23):5984. doi: 10.3390/cancers14235984.
The role of surgical experience and its impact on the survival requires further investigation. A cohort of patients undergoing radical cystectomy or anterior pelvic exenteration for localized bladder cancer between 2006 and 2013 at 1143 facilities across the United States was identified using the National Cancer Database and analyzed. Using overall survival (OS) as the primary outcome, the relationship between facility annual caseload (FAC) and facility annual surgical caseload (FASC) for those undergoing curative surgery was examined. Four volume groups (VG) depending on caseload using both FAC and FASC were defined. These included VG1: below 50th percentile, VG2: 50th−74th percentile, VG3: 75th−89th percentile, and VG4: 90th and above. Between 2006 and 2013, 27,272 patients underwent surgery for localized bladder cancer. The median OS was 59.66 months (95% CI: 57.79−61.77). OS improved significantly as caseload increased. The unadjusted median OS difference between VG1 and VG4 was 15.35 months (64.3 vs. 48.95 months, HR 1.19 95% CI: 1.13−1.25, p < 0.001) for FAC. This figure was 19.84 months (66.89 vs. 47.05 months, HR 1.25 95% CI: 1.18−1.32, p < 0.0001) for FASC. This analysis revealed a significant and clinically important survival advantage for curative bladder cancer surgery at highly experienced centers.
手术经验的作用及其对生存率的影响需要进一步研究。利用美国国立癌症数据库识别并分析了2006年至2013年期间在美国1143家医疗机构接受根治性膀胱切除术或前盆腔脏器清除术治疗局限性膀胱癌的一组患者。以总生存期（OS）作为主要结局，研究了接受根治性手术患者的机构年度病例数（FAC）与机构年度手术病例数（FASC）之间的关系。根据FAC和FASC的病例数定义了四个容量组（VG）。这些组包括VG1：低于第50百分位数，VG2：第50 - 74百分位数，VG3：第75 - 89百分位数，以及VG4：第90百分位数及以上。2006年至2013年期间，27272例患者接受了局限性膀胱癌手术。中位OS为59.66个月（95%CI：57.79 - 61.77）。随着病例数增加，OS显著改善。FAC方面，VG1和VG4之间未经调整的中位OS差异为15.35个月（64.3对48.95个月，HR 1.19，95%CI：1.13 - 1.25，p < 0.001）。FASC方面，该数字为19.84个月（66.89对47.05个月，HR 1.25，95%CI：1.18 - 1.32，p < 0.0001）。该分析揭示了在经验丰富的中心进行根治性膀胱癌手术具有显著且具有临床重要性的生存优势。
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