Impact of hospital case volume on testicular cancer outcomes and practice patterns

Solomon L. Woldu, Justin T. Matulay, Timothy N. Clinton, Nirmish Singla, Laura Maria Krabbe, Ryan Craig Hutchinson, Arthur I Sagalowsky, Yair Lotan, Vitaly Margulis, Aditya Bagrodia

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns. Materials and methods: The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95-99th percentile, 14.6-26.0 cases annually), intermediate (75-95th percentile, 6.1-14.5 cases annually), low-intermediate (25-75th percentile, 1.8-6.0 cases annually), and low (25th percentile,<1.8 cases annually). The median (interquartile range) number of TGCT cases per institution per year was 3.4 (1.8-6.1). Results: A total of 33,417 patients with TGCT diagnosed from 1,239 institutions met inclusion criteria. Despite worse disease characteristics of patients treated at higher volume institutions, hospital volume was positively associated with survival outcomes in more advanced cases of TGCT. In the overall cohort, compared to the high-volume hospitals, patients treated at high-intermediate, intermediate, low-intermediate, and low volume hospitals the hazard ratio for overall mortality was 1.28, 1.45, 1.48, and 1.83, respectively (P<0.05). The association between survival and hospital volume was not apparent for seminoma or stage I NSGCT. Patients treated at higher volume hospitals were more likely to undergo surveillance for stage I seminoma, primary retroperitoneal lymph node dissection (RPLND) for stage I NSGCT, and postchemotherapy RPLND for stage II/III NSGCT. Conclusions: Our analysis of a nationwide cancer registry demonstrated that increased hospital TGCT case volume was associated with significant differences in management strategies and improved survival outcomes, in particular for more advanced disease.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - 2017

Fingerprint

Testicular Neoplasms
High-Volume Hospitals
Seminoma
Survival
Tumor Burden
Lymph Node Excision
Low-Volume Hospitals
Registries
Neoplasms
Testicular Germ Cell Tumor
Databases
Mortality
Nonseminomatous germ cell tumor

Keywords

  • Centralization
  • Outcomes
  • Testicular cancer
  • Treatment
  • Volume

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Impact of hospital case volume on testicular cancer outcomes and practice patterns. / Woldu, Solomon L.; Matulay, Justin T.; Clinton, Timothy N.; Singla, Nirmish; Krabbe, Laura Maria; Hutchinson, Ryan Craig; Sagalowsky, Arthur I; Lotan, Yair; Margulis, Vitaly; Bagrodia, Aditya.

In: Urologic Oncology: Seminars and Original Investigations, 2017.

Research output: Contribution to journalArticle

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abstract = "Background: Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns. Materials and methods: The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95-99th percentile, 14.6-26.0 cases annually), intermediate (75-95th percentile, 6.1-14.5 cases annually), low-intermediate (25-75th percentile, 1.8-6.0 cases annually), and low (25th percentile,<1.8 cases annually). The median (interquartile range) number of TGCT cases per institution per year was 3.4 (1.8-6.1). Results: A total of 33,417 patients with TGCT diagnosed from 1,239 institutions met inclusion criteria. Despite worse disease characteristics of patients treated at higher volume institutions, hospital volume was positively associated with survival outcomes in more advanced cases of TGCT. In the overall cohort, compared to the high-volume hospitals, patients treated at high-intermediate, intermediate, low-intermediate, and low volume hospitals the hazard ratio for overall mortality was 1.28, 1.45, 1.48, and 1.83, respectively (P<0.05). The association between survival and hospital volume was not apparent for seminoma or stage I NSGCT. Patients treated at higher volume hospitals were more likely to undergo surveillance for stage I seminoma, primary retroperitoneal lymph node dissection (RPLND) for stage I NSGCT, and postchemotherapy RPLND for stage II/III NSGCT. Conclusions: Our analysis of a nationwide cancer registry demonstrated that increased hospital TGCT case volume was associated with significant differences in management strategies and improved survival outcomes, in particular for more advanced disease.",
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author = "Woldu, {Solomon L.} and Matulay, {Justin T.} and Clinton, {Timothy N.} and Nirmish Singla and Krabbe, {Laura Maria} and Hutchinson, {Ryan Craig} and Sagalowsky, {Arthur I} and Yair Lotan and Vitaly Margulis and Aditya Bagrodia",
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T1 - Impact of hospital case volume on testicular cancer outcomes and practice patterns

AU - Woldu, Solomon L.

AU - Matulay, Justin T.

AU - Clinton, Timothy N.

AU - Singla, Nirmish

AU - Krabbe, Laura Maria

AU - Hutchinson, Ryan Craig

AU - Sagalowsky, Arthur I

AU - Lotan, Yair

AU - Margulis, Vitaly

AU - Bagrodia, Aditya

PY - 2017

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N2 - Background: Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns. Materials and methods: The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95-99th percentile, 14.6-26.0 cases annually), intermediate (75-95th percentile, 6.1-14.5 cases annually), low-intermediate (25-75th percentile, 1.8-6.0 cases annually), and low (25th percentile,<1.8 cases annually). The median (interquartile range) number of TGCT cases per institution per year was 3.4 (1.8-6.1). Results: A total of 33,417 patients with TGCT diagnosed from 1,239 institutions met inclusion criteria. Despite worse disease characteristics of patients treated at higher volume institutions, hospital volume was positively associated with survival outcomes in more advanced cases of TGCT. In the overall cohort, compared to the high-volume hospitals, patients treated at high-intermediate, intermediate, low-intermediate, and low volume hospitals the hazard ratio for overall mortality was 1.28, 1.45, 1.48, and 1.83, respectively (P<0.05). The association between survival and hospital volume was not apparent for seminoma or stage I NSGCT. Patients treated at higher volume hospitals were more likely to undergo surveillance for stage I seminoma, primary retroperitoneal lymph node dissection (RPLND) for stage I NSGCT, and postchemotherapy RPLND for stage II/III NSGCT. Conclusions: Our analysis of a nationwide cancer registry demonstrated that increased hospital TGCT case volume was associated with significant differences in management strategies and improved survival outcomes, in particular for more advanced disease.

AB - Background: Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns. Materials and methods: The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95-99th percentile, 14.6-26.0 cases annually), intermediate (75-95th percentile, 6.1-14.5 cases annually), low-intermediate (25-75th percentile, 1.8-6.0 cases annually), and low (25th percentile,<1.8 cases annually). The median (interquartile range) number of TGCT cases per institution per year was 3.4 (1.8-6.1). Results: A total of 33,417 patients with TGCT diagnosed from 1,239 institutions met inclusion criteria. Despite worse disease characteristics of patients treated at higher volume institutions, hospital volume was positively associated with survival outcomes in more advanced cases of TGCT. In the overall cohort, compared to the high-volume hospitals, patients treated at high-intermediate, intermediate, low-intermediate, and low volume hospitals the hazard ratio for overall mortality was 1.28, 1.45, 1.48, and 1.83, respectively (P<0.05). The association between survival and hospital volume was not apparent for seminoma or stage I NSGCT. Patients treated at higher volume hospitals were more likely to undergo surveillance for stage I seminoma, primary retroperitoneal lymph node dissection (RPLND) for stage I NSGCT, and postchemotherapy RPLND for stage II/III NSGCT. Conclusions: Our analysis of a nationwide cancer registry demonstrated that increased hospital TGCT case volume was associated with significant differences in management strategies and improved survival outcomes, in particular for more advanced disease.

KW - Centralization

KW - Outcomes

KW - Testicular cancer

KW - Treatment

KW - Volume

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