Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database

Shyh-Chyi Chang; Chia-Hao Hsu; Yi-Chu Lin; Szu-Yuan Wu

doi:10.3390/cancers13030488

Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database

Cancers (Basel). 2021 Jan 27;13(3):488. doi: 10.3390/cancers13030488.

Authors

Shyh-Chyi Chang^{1

2}, Chia-Hao Hsu^{1

2}, Yi-Chu Lin¹, Szu-Yuan Wu^{3

4

5

6

7

8}

Affiliations

¹ Division of Urology, Department of Surgery, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
² Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11221, Taiwan.
³ Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.
⁴ Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
⁵ Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
⁶ Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.
⁷ Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 256, Taiwan.
⁸ Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei 242062, Taiwan.

Abstract

Purpose: To examine the effect of hospital volume on positive surgical margin (PSM) and biochemical-failure-free survival (BFS) rates in patients with prostate cancer (PC) undergoing robotic-assisted or nonrobotic-assisted radical prostatectomy (RP).

Patients and methods: The patients were men collected in the National Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP from 44 multi-institutes in Taiwan. The logistic regression method was used to analyze the risk from RP to PSM in included patients with hospital volume (i.e., number of patients with PC receiving robotic RP per year), and the Cox proportional hazards method was used to analyze the time from the index date to biochemical recurrence.

Results: After propensity score adjustment, compared with hospitals with >100 patients/year, the adjusted odds ratios (aORs; 95% confidence intervals) of PSM in the robotic RP group in hospitals with 1-25, 26-50, and 51-100 patients/year were 2.25 (2.10-3.11), 1.42 (1.25-2.23), and 1.33 (1.13-2.04), respectively (type III p < 0.0001). Sensitivity analysis indicated that the aORs of PSM were 1.29 (1.07-1.81), 1.07 (0.70-1.19), and 0.61 (0.56-0.83), respectively, for patients receiving robotic RP compared with nonrobotic RP within hospitals with 1-25, 26-50, and 51-100 patients/year, respectively. Compared with hospitals with >100 patients/year, the adjusted hazard ratios (aHRs) of biochemical failure in the robotic RP group were 1.40 (1.04-1.67), 1.34 (1.06-1.96), and 1.31 (1.05-2.15) in hospitals with 1-25, 26-50, and 51-100 patients/year, respectively.

Conclusions: Hospital volume significantly affected PSM and BFS in robotic RP, but not in nonrobotic RP. When patients with PC want to receive robotic RP, it should be performed in a relatively high-volume hospital (>100 patients/year).

Keywords: biochemical-failure-free survival; hospital volume; nonrobotic radical prostatectomy; positive surgical margin; robotic radical prostatectomy.