Practice Patterns and Impact of Postchemotherapy Retroperitoneal Lymph Node Dissection on Testicular Cancer Outcomes
| Autor: | Aditya Bagrodia, Nirmish Singla, Ryan Hutchinson, Yang Xie, Bo Ci, Yair Lotan, Laura Maria Krabbe, James F. Amatruda, Timothy Clinton, Ahmet M. Aydin, Solomon L. Woldu, Arthur I. Sagalowsky, Yuval Freifeld, Vitaly Margulis, Yull Edwin Arriaga, Joseph A. Moore |
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| Rok vydání: | 2018 |
| Předmět: |
Oncology
medicine.medical_specialty Practice patterns business.industry Proportional hazards model Urology medicine.medical_treatment 030232 urology & nephrology Logistic regression medicine.disease 03 medical and health sciences Retroperitoneal lymph node dissection 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Propensity score matching medicine Radiology Nuclear Medicine and imaging Surgery Observational study Germ cell tumors business Testicular cancer |
| Zdroj: | European Urology Oncology. 1:242-251 |
| ISSN: | 2588-9311 |
| Popis: | Background Owing to surgical complexity and controversy regarding indications, there are wide practice variations in the use of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Objective To evaluate patterns of PC-RPLND use in the USA and evaluate the association between PC-RPLND and survival in advanced nonseminomatous germ cell tumors (NSGCTs). Design, setting, and participants A retrospective, observational study using National Cancer Data Base (NCDB) data from 2004–2014 for 5062 men diagnosed with stage II/III NSGCT. Outcome measurements and statistical analysis In a comparative analysis based on receipt of PC-RPLND, the primary outcome of interest was factors associated with omission of PC-RPLND as explored via logistic regression. As a secondary outcome, we evaluated the association between PC-RPLND and overall survival (OS) via multivariable Cox regression and propensity score matching (PSM). Results and limitations Patients undergoing PC-RPLND were more likely to be younger, white, privately insured, and reside in more educated/wealthier regions (p Conclusions PC-RPLND represents a critical part of the multidisciplinary management of NSGCT. Patients with non-private insurance are less likely to undergo PC-RPLND, and omission of PC-RPLND is associated with lower OS. Patient summary We evaluated the practice patterns for advanced testicular cancer management and found that patients who did not undergo a postchemotherapy retroperitoneal lymph node dissection were more likely to have worse survival outcomes. Patients with unfavorable insurance were less likely to receive this surgical treatment. |
| Databáze: | OpenAIRE |
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