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dc.contributor.authorHsu, Rayen
dc.contributor.authorBarclay, Matthewen
dc.contributor.authorLoughran, Mollyen
dc.contributor.authorLyratzopoulos, Georgiosen
dc.contributor.authorGnanapragasam, Vincenten
dc.contributor.authorArmitage, Jamesen
dc.date.accessioned2019-06-21T14:55:26Z
dc.date.available2019-06-21T14:55:26Z
dc.identifier.issn1464-410X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/293863
dc.description.abstractOBJECTIVE To evaluate the relationship between hospital volume and intermediate and long-term patient survival for patients undergoing nephrectomy for renal cell carcinoma (RCC). PATIENTS & METHODS Adult RCC patients treated with nephrectomy between 2000 and 2010 were identified from the English Hospital Episode Statistics and National Cancer Data Repository. Patients with nodal or metastatic disease were excluded. Hospitals were categorised into low (<20/yr), medium (20-39/yr) and high (40/yr) volume based on annual cases of RCC nephrectomy. Multivariable Cox regressions were used to calculate hazard ratios for all-cause mortality by hospital volume, adjusting for patient, tumour and surgical characteristics. We assessed conditional survival over three follow-up periods: short (30d-1yr), intermediate (1-3yr) and long (3-5yr). We additionally explored whether associations between volume and outcomes varied by tumour stage. RESULTS 12,912 patients were included. Patients in high volume hospitals had 34% reduction in mortality risks up to one year compared to those in low volume hospitals (HR 0.66, 95% CI 0.53-0.83, p<0.01). Assuming causality, treatment in high volume hospitals was associated with one fewer death in every 71 patients treated. Benefit of nephrectomy centralisation did not change with higher T stage (p=0.17). No significant association between hospital volume and survival was observed beyond the first year. CONCLUSIONS RCC nephrectomy in high volume hospitals was associated with improved survival for up to one year after treatment. Our results contribute new insights regarding the value of nephrectomy centralisation.
dc.description.sponsorshipThe Urology Foundation Addenbrooke's Charitable Trust Royal College of Surgeons of England
dc.publisherBlackwell Publishing Inc.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleImpact of Hospital Nephrectomy Volume on Intermediate to Long-term Survival in Renal Cell Carcinomaen
dc.typeArticle
prism.publicationNameBritish Journal of Urology (BJU) Internationalen
dc.identifier.doi10.17863/CAM.40972
dcterms.dateAccepted2019-06-10en
rioxxterms.versionofrecord10.1111/bju.14848en
rioxxterms.versionAM*
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2019-06-10en
dc.contributor.orcidBarclay, Matthew [0000-0003-1148-1922]
dc.contributor.orcidLyratzopoulos, Georgios [0000-0002-2873-7421]
dc.contributor.orcidGnanapragasam, Vincent [0000-0003-4722-4207]
dc.identifier.eissn1464-410X
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idUrology Foundation (Research Scholarship Applicati)
pubs.funder-project-idAddenbrooke's Charitable Trust (ACT) (241/15 A/Hsu)
cam.issuedOnline2019-06-17en
dc.identifier.urlhttps://onlinelibrary.wiley.com/doi/abs/10.1111/bju.14848en


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International