Validation of quality indicators for radical prostatectomy

Chan, Ellen; Groome, Patti A.

doi:10.1002/ijc.23782

Cited by 18 publications

(12 citation statements)

References 53 publications

(87 reference statements)

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“…The positive margin rate in British Columbia in pT3 cases (57%) are also comparable to the range of regional rates seen in Ontario (42%-83%), 11 and within the ranges of rates reported in the literature (24%-80%). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In comparison to the recent large SEER series, need for, and use of, post prostatectomy radiotherapy our margin positive rates exceed those reported for SEER (18% for pT2, and 44% for pT3). 39 Unlike the SEER study, which was also population-based, our study detailed patient data on postoperative PSA, which allowed us to distinguish adjuvant and early salvage radiotherapy.…”

Section: Discussioncontrasting

confidence: 63%

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Tyldesley

Peacock

Morris

et al. 2012

CUAJ

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Introduction: Three randomized trials have demonstrated that post-radical prostatectomy (RP) radiotherapy decreases biochemical relapse for those with adverse pathology. Our purpose was to describe the incidence of pathologic risk factors for recurrence in a contemporary series of patients treated with RP and to describe the use of post-RP radiotherapy. Methods: All incident prostate cancers diagnosed between January 2005 and December 2007 were identified from the tumour registry. Cases were then linked to radiotherapy records which included dose and modality (external beam radiotherapy and brachytherapy). The pathology reports in the tumour registry were reviewed for pathologic stage, grade and margin status. Results: We identified 9223 patients with prostate cancer. Overall, 36.3% of patients treated with RP had positive margins, and may have benefited from adjuvant radiotherapy. After RP, 332 (15%) patients had radiotherapy to the prostate bed; of these, only 25 (1.1%) received truly adjuvant radiotherapy (delivered within 6 months with a prostate-specific antigen of <0.2 ng/mL). Of the 2181 patients treated with RP, 270 (12%) were seen by a radiation oncologist within 6 months of RP. Of the 1015 patients (47%) with adverse RP pathology (positive margins, extracapsular extension or seminal vesicle invasion), 230 (23%) were seen by a radiation oncologist within 6 months of RP. Conclusion: Not all patients with adverse prostatectomy pathology were seen by a radiation oncologist post-prostatectomy, and very few received adjuvant radiotherapy despite almost half of them having risk factors for relapse.

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Section: Discussioncontrasting

confidence: 63%

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Tyldesley

Peacock

Morris

et al. 2012

CUAJ

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“…The finding that surgery in a lower-volume hospital is associated with poorer long-term cause-specific survival is consistent with our a priori hypotheses and previous research, which has studied intermediate outcomes such as hospital readmission. [15][16][17][18][19][20][21][22][23][24][25][26] This volume effect was not due to older patients or patients with more severe disease or comor- Quality of care indicators and related outcomes bidities being referred to higher-volume centres. We are not aware of any other studies that have examined long-term survival following RP in relation to hospital volume.…”

Section: Discussionmentioning

confidence: 99%

Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radical prostatectomy

Webber

Brundage

Groome

2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(7-8):e572-9. http://dx.doi.org/10.5489/cuaj.1649 Published online August 11, 2014. AbstractIntroduction: We evaluated the validity of 8 quality of care indicators for prostate cancer patients treated curatively with radical prostatectomy (RP) by examining their association with indicatorrelevant outcomes. Methods:We conducted a population-based retrospective cohort study of 646 prostate cancer patients diagnosed between 1990 and 1998 who received RP within 6 months of diagnosis. Data were collected from treating charts and linked to registry and administrative data. Quality indicators included: hospital volume, pre-treatment risk assessment, consultation with a radiation oncologist, appropriate follow-up care, nerve-sparing surgery, units of blood transfused, surgical margin status, and pelvic lymph node dissection during RP. Indicator-relevant outcomes were selected a priori by clinical members of the research team. The associations between indicators and their relevant outcomes were analyzed using regression techniques, to control for potential confounders. Results: Of the quality indicators evaluated, only hospital volume was statistically significantly associated with the gradient in the expected direction. Patients treated in the lowest-volume hospitals (<1 RP/month) had lower cause-specific survival rates compared to patients treated in the highest-volume hospitals (≥7 RP/month) (HR=4.71 95%; CI 1.06-20.82). Completeness of follow-up care was associated with cause-specific survival but in the opposite direction to our hypothesis. Conclusion: The structural indicator of hospital volume was associated with cause-specific survival in accordance with our a priori hypothesis. Our negative findings for completeness of follow-up care call its validity into question. Issues of statistical power and measurement accuracy may have affected our validation of the remaining indicators underscoring the challenges in assessing the impact of accepted quality indicators.

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“…Results from those other objectives have been reported separately. 7,8 A stratified (by region of residence) random sample of about 10% of all patients and 59% of all cases formed the cohort (n = 1703) and case groups (n = 632, with 122 of selected for both the cohort and cases as per the casecohort design), for a total study population of 2213. Of these, 114 were ineligible or had insufficient treatment information available in the charts (Fig.…”

Section: Methodsmentioning

confidence: 99%

Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

DeGroot

Brundage

Lam

et al. 2013

CUAJ

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E299Cite as: Can Urol Assoc J 2013;7(5-6):e299-305. http://dx.doi.org/10.5489/cuaj.11294 Published online May 13, 2013 (early released July 16, 2012). AbstractObjective: We compared the cause-specific survival of patients who received radiotherapy to those who received surgery for cure of their prostate cancer using a number of design and analytic steps to mitigate confounding by indication. Methods: This was a case-cohort study of 2213 patients in the Ontario Cancer Registry diagnosed between 1990 and 1998 who were either treatment candidates or received curative radiotherapy or surgery. Cases included patients who died of prostate cancer within 10 years. The study population was restricted to those who were candidates for either treatment (radiotherapy or surgery) based on disease severity (low and intermediate risk using the Genitourinary Radiation Oncologists of Canada risk groups). The median follow-up was 51 months. Cause-specific survival was analyzed using Cox-proportional hazards regression with casecohort variance adjustment. Results from intent-to-treat analyses were compared to results by treatment received. Results: Adjusted hazard ratios for risk of prostate cancer death for radiotherapy compared to surgery for the entire study population were 1.62 (95%CI 1.00-2.61) and 2.02 (1.19-3.43) analyzing by intent-to-treat and treatment received, respectively. Intent-to-treat hazard ratios for the low-and intermediate-risk groups were 0.87 (0.28-2.76) and 1.57 (0.95-2.61), respectively. Conclusion: Overall results were driven by the finding in the intermediate-risk group, which indicated that radiotherapy was not as effective as surgery in this group. Confirmation was needed with special attention paid to risk stratification and the impact of more contemporary delivery of these treatment options.

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Validation of quality indicators for radical prostatectomy

Cited by 18 publications

References 53 publications

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radical prostatectomy

Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy

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