title: Variations in treatment policies and outcome for bladder cancer in the Netherlands.
abstract: OBJECTIVE
  To describe the population-based variation in treatment policies and outcome for bladder cancer in the Netherlands.
  
  
  METHODS
  All newly diagnosed patients with primary bladder cancers during 2001-2006 were selected from the Netherlands Cancer Registry (n = 29,206). Type of primary treatment was analysed according to Comprehensive Cancer Centre region, hospital type (academic, non-academic teaching or other hospitals) and volume (< or =5, 6-10 or >10 cystectomies yearly). For stage II-III patients undergoing cystectomy we analyzed the proportion of lymph node dissections and 30-days mortality.
  
  
  RESULTS
  44% of patients with stage II-III bladder cancer underwent cystectomy, while 26% were not treated with curative intent. Cystectomy was the preferred option in three of nine regions, radiotherapy in two, and two regions waived curative treatment more often. Between 2001 and 2006 the number of cystectomies increased with 20% (n = 108). Twenty-one percent (n = 663) of these procedures were performed in 44 low-volume hospitals. In 79% of the cystectomies lymph node dissections were performed, more often in high and medium-volume centers (82% and 81% respectively) than in low-volume hospitals (71%, the odds ratio being 1.5). The overall 30-days post-operative mortality rate was 3.4% and increased with older age. It was significantly lower in high-volume centers (1.2%).
  
  
  CONCLUSIONS
  Treatment policies for muscle-invasive bladder cancer in the Netherlands showed regional preferences and a gradual increase of cystectomy. Cystectomy albeit considered as golden standard, was performed in a minority of the muscle-invasive cases. In high-volume institutions, lymph node dissection rates were higher and post-operative mortality rates were lower.
authors.affiliation: Department of Urology, Utrecht University Medical Center (affiliated with St. Elisabeth Hospital, Department of Urology), Utrecht, The Netherlands. C.A.Laan-2@umcutrecht.nl
authors.forename: C A
authors.initials: CA
authors.lastname: Goossens-Laan
authors.forename: O
authors.initials: O
authors.lastname: Visser
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: M L E A
authors.initials: ML
authors.lastname: Jansen-Landheer
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: M C C M
authors.initials: MC
authors.lastname: Hulshof
authors.forename: P J M
authors.initials: PJ
authors.lastname: Kil
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011787:Quality of Health Care; D012042:Registries; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*