The Impact of Centralised Services on Metric Reflecting High-quality Performance: Outcomes from 1110 Consecutive Radical Cystectomies at a Single Centre

Pang, Karl H.; Thomas, Francis T.; Novara, Giacomo; Din, Omar; Morgan, Susan; Hussain, Syed A.; Jubber, Ibrahim; Noon, Aidan P.; Catto, James W.F.; Rosario, Derek J.

doi:10.1016/j.euf.2020.05.011

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…UTUC had a higher proportion of MI cancer and unknown stage when compared to BC (chi‐squared P < 0.001). Tumour grade was only available for pTa/Tis BCs (as most MI and T1 tumours are high‐grade [ 17 ]). Most of these BCs were low (Grade 1, 2993 [5%]) or moderate grade (Grade 2, 27 727 [48%]), compared to 8100 (14%) that were high grade (Grade 3).…”

Section: Resultsmentioning

confidence: 99%

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real‐world findings from NHS England between 2013 and 2019

et al. 2023

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We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019. Materials and MethodsHospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital. ResultsRegistrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-weekwait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n = 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers. ConclusionThe diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.

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Section: Resultsmentioning

confidence: 99%

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real‐world findings from NHS England between 2013 and 2019

et al. 2023

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“…Due to the nature of Premier, we were unable to determine the post‐operative outcomes following vasal reconstruction, limiting our ability to truly evaluate the relationship between surgeon volume and outcomes. Nonetheless, these data raise the possibility for consideration of centralisation of microsurgical male reproductive reconstruction in centres of excellence, among high‐volume surgeons with specialised training, as has been suggested for oncologic surgeries such as radical cystectomy and others (Pang et al., 2021). However, further studies are needed to better assess the volume–outcome relationship before such an effort can be implemented on a broad scale.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns of vasal reconstruction in a large United States cohort

et al. 2021

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Approximately 500,000 vasectomies are performed annually in the United States (US), and vasectomy is the most common cause of obstructive azoospermia (Ostrowski et al., 2018; The Evaluation of the Azoospermic Male -American Urological Association). For men seeking fertility after vasectomy, the two options are sperm retrieval with assisted reproductive technology or microsurgical reconstruction in the form of a vasovasostomy (VV) or vasoepididymostomy (VE). Vasal reconstruction is the only option that offers couples the opportunity to conceive children naturally and may additionally provide a more cost-effective option for achieving pregnancy, especially if there is a desire for multiple children (Goldstein & Tanrikut, 2006;

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“…54 Five-year CSS rates in HR-NMIBC patients were reported by 12 studies and ranged between 71% and 96%. 27,37,41,42,46,73,76,88,94,98,102,104 The study reporting the lowest rate was in patients who did not respond to intravesical BCG. 76 Two studies reported 10-year CSS, which was achieved in the majority of patients (85% and 92%).…”

Section: Dovepressmentioning

confidence: 98%

Treatment Outcomes of High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) in Real-World Evidence (RWE) Studies: Systematic Literature Review (SLR)

Musat¹,

Kwon²,

Masters³

et al. 2022

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Background: To date, there has been limited synthesis of RWE studies in high-risk nonmuscle invasive bladder cancer (HR-NMIBC). The objective of this research was to conduct a systematic review of published real-world evidence to better understand the real-world burden and treatment patterns in HR-NMIBC. Methods: An SLR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the scope defined by the Population, Intervention Comparators, Outcomes, and Study design (PICOS) criteria. EMBASE, MEDLINE, and Cochrane databases (Jan 2015-Jul 2020) were searched, and relevant congress abstracts (Jan 2018-Jul 2020) identified. The final analysis only included studies that enrolled ≥100 patients with HR-NMIBC from the US, Europe, Canada, and Australia. Results: The SLR identified 634 RWE publications in NMIBC, of which 160 studies reported data in HR-NMIBC. The average age of patients in the studies was 71 years, and 79% were males. The rates of BCG intravesical instillations ranged from 3% to 86% (29-95% for induction and 8-83% for maintenance treatment). Five-year outcomes were 17-89% recurrence-free survival (longest survival in patients completing BCG maintenance), 58-89% progression-free survival, 71-96% cancer-specific survival (lowest survival in BCG-unresponsive patients), and 28-90% overall survival (lowest survival in patients who did not receive BCG or instillation therapy). Conclusion: BCG treatment rates and survival outcomes in patients with HR-NMIBC vary in the real world, with better survival seen in patients completing maintenance BCG, responding to treatment, and not progressing to muscle-invasive disease. There is a need to better understand the factors associated with BCG use and discontinuation and for an effective treatment that improves outcomes in HR-NMIBC. Generalization of these results is limited by variations in data collection, reporting, and methodologies used across RWE studies.

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The Impact of Centralised Services on Metric Reflecting High-quality Performance: Outcomes from 1110 Consecutive Radical Cystectomies at a Single Centre

Cited by 8 publications

References 28 publications

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real‐world findings from NHS England between 2013 and 2019

Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real‐world findings from NHS England between 2013 and 2019

Practice patterns of vasal reconstruction in a large United States cohort

Treatment Outcomes of High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) in Real-World Evidence (RWE) Studies: Systematic Literature Review (SLR)

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