title: Centralization of Penile Cancer Management in the United States: A Combined Analysis of the American Board of Urology and National Cancer Data Base.
abstract: OBJECTIVE
  To assess the potential benefit of centralization of care in penile cancer. Centralization of care in other disease processes standardizes treatment and improves outcomes. Because penile cancer is a rare malignancy with unchanged mortality rates over the last two decades, we hypothesize that there may be a benefit to centralization.
  
  
  METHODS
  We identified surgeon, patient, and hospital characteristics captured by the National Cancer Data Base (1998-2012) and American Board of Urology case logs (2003-2013) for all penile cancer cases and procedures. Differences in patient demographics, stage of disease, referral patterns, and surgical quality indicators were assessed between academic and community hospitals.
  
  
  RESULTS
  Using case logs to evaluate the distribution of penile cancer care, we found that only 4.1% of urologists performed a penile surgery and 1.5% performed a lymph node dissection (LND). Academic centers treated higher-stage cancers and saw more cases/year than community centers, suggesting informal centralization. Two guideline-based quality indicators demonstrated no difference in use of penile-sparing surgery but a higher likelihood of having an LND performed at an academic center (48.4% vs 26.6%). The total lymph node yield was significantly greater at academic centers (18.5 vs 12.5). Regression modeling demonstrated a 2.29 increased odds of having an LND at an academic center.
  
  
  CONCLUSIONS
  Our data provide the first evidence for centralization of penile cancer in the US. At the time of diagnosis, equal number of patients is treated with penile-sparing surgery but there is greater use of LND and higher lymph node yield at academic centers. Ultimately, longer follow-up is necessary to determine if this improves survival of patients with penile cancer.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: richard.matulewicz@northwestern.edu.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Matulewicz
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Flum
authors.affiliation: Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Irene
authors.initials: I
authors.lastname: Helenowski
authors.affiliation: Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Borko
authors.initials: B
authors.lastname: Jovanovic
authors.affiliation: American College of Surgeons, Chicago, IL.
authors.forename: Bryan
authors.initials: B
authors.lastname: Palis
authors.affiliation: Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D000368:Aged; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013044:Specialty Boards; D014481:United States; D014572:Urology / Q000458:organization & administration