title: Variations in pelvic lymph node dissection in invasive bladder cancer: A Dutch nationwide population-based study during centralization of care.
abstract: To assess temporal trends in radical cystectomy (RC) and pelvic lymph node dissection (PLND) and the effect of centralization of care in the Netherlands between 2006 and 2012.
  
  
  
  This nationwide population-based study included 3524 patients from the Netherlands Cancer Registry who underwent RC as the primary treatment for cT1-4a, N0 or Nx, M0 urothelial carcinoma. Annual application rates of PLND, median LNC, and rates of node-positive disease (pN+) were compared by linear-by-linear association. Multivariable logistic regression was performed to identify patients׳ and hospital characteristics associated with PLND and LNC≥10, and to study associations between LNC and pN+disease.
  
  
  
  In total, 3,191 (91%) patients had PLND during RC and the use increased from 84% in 2006 to 96% in 2012 (P<0.001). Owing to centralization of care in 2010 (at least 10RCs/y/hospital), significantly more patients were treated in high-volume hospitals (≥20RC per year) in 2011 and 2012. PLND use was highest in males, younger patients and in academic, teaching, and high-volume hospitals (≥20RC per year). In 2012, PLND application rates were comparable for academic, teaching, and nonteaching hospitals (P = 0.344). Median LNC increased from 7 in 2006 to 13 in 2012 (P<0.001), 55% had an LNC≥10 (63% in 2012). Furthermore, lymph node count (LNC)≥10 was associated with cT3-4a and, pN+disease, R0 and treatment in academic, teaching, or high-volume hospitals (≥20RC per year). Rate of pN+disease increased from 18% to 24% between 2006 and 2012 (P = 0.014). This trend was significantly associated with increased LNC on a continuous scale (odds ratio = 1.03).
  
  
  
  After centralization of care, PLND during RC for cT1-4a, N0 or Nx, M0 urothelial carcinoma has become standard in all types of Dutch hospitals. The increase in LNC between 2006 and 2012 was associated with a higher incidence of pN+disease and suggests more adequate template extension and adherence to contemporary guidelines in recent years.
authors: Division of Urology, Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Tom Johannes Noël
authors: TJ
authors: Hermans
authors: Division of Urology, Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Elisabeth Ernestine
authors: EE
authors: Fransen van de Putte
authors: Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands.
authors: Laurent Marie Constant Leo
authors: LM
authors: Fossion
authors: Department of Biometrics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Erik van
authors: EV
authors: Werkhoven
authors: Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
authors: Rob Henricus Andreas
authors: RH
authors: Verhoeven
authors: Division of Urology, Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: basvanrhijn@hotmail.com.
authors: Bas Wilhelmus Gerardus
authors: BW
authors: van Rhijn
authors: Division of Urology, Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Simon
authors: S
authors: Horenblas
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D015653:Cystectomy / Q000379:methods* / Q000639:trends; D005260:Female; D019983:Guideline Adherence; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009426:Netherlands; D010388:Pelvis; D017410:Practice Guidelines as Topic; D012042:Registries; D059039:Standard of Care; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents
keywords: Bladder cancer; Centralization; Lymph node count; Lymph node dissection; Population-based; Staging