Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada

Authors

  • Michael Melcalfe University of British Columbia, Vancouver, BC
  • Wassim Kassouf McGill University, Montreal, QC
  • Ricardo Rendon Dalhousie University, Halifax, NS
  • David Bell Dalhousie University, Halifax, NS
  • Jonathan Izawa University of Western Ontario, London, ON
  • Joseph Chin University of Western Ontario, London, ON
  • Anil Kapoor McMaster University, Hamilton, ON
  • Edward Matsumoto McMaster University, Hamilton, ON
  • Jean-Baptiste Lattouf University of Montreal, Montreal, QC
  • Fred Saad University of Montreal, Montreal, QC
  • Louis Lacombe Laval University, Quebec, QC
  • Yves Fradet Laval University, Quebec, QC
  • Adrian Fairey University of Alberta, Edmonton, AB
  • Niels-Eric Jacobson University of Alberta, Edmonton, AB
  • Darrel Drachenberg University of Manitoba, Winnipeg, MB
  • Ilias Cagiannos University of Ottawa, Ottawa, ON
  • Alan So University of British Columbia, Vancouver, BC
  • Peter Black University of British Columbia, Vancouver, BC

DOI:

https://doi.org/10.5489/cuaj.116

Abstract

Introduction: We delineated Canadian regional differences in practice patterns in the management of upper tract urothelial carcinoma (UTUC) after nephroureterectomy and relate these to patient outcomes.

Methods: A database was created with 1029 patients undergoing radical nephroureterectomy for UTUC between 1994 and 2009 at 10 Canadian centres. Demographic, clinical and pathological variables were collected from chart review. Practice pattern variables were defined as: open versus laparoscopic nephroureterectomy, management strategy for the distal ureter, performance of lymphadenectomy and administration of chemotherapy and/or radiation therapy. The outcome measures were overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). The centres were divided into three regions (West, Central, East). Cox proportional multivariable linear regression analysis was used to determine the association between regional differences in practice patterns and clinical outcomes.

Results: There was a significant difference in practice patterns between regions within Canada for: time from diagnosis to surgery (p = 0.001), type of surgery (open vs. laparoscopic, p < 0.01) and method of management of the distal ureter (p = 0.001). As well, there were significant differences in survival between regions across Canada: 5-year OS (West 70%, Central 81% and East 62%, p < 0.0001) and DSS (West=79%, Central=85%, East=75%, p = 0.007) were significantly different, but there was no difference in RFS (West 47%, Central 48%, East 46%, p = 0.88). Multivariable linear regression analysis demonstrated that the differences in survival were independent of region OS (p = 0.78), DSS (p = 0.30) or RFS (p = 0.43).

Conclusion: There is significant disparity in practice patterns between regions within Canada, but these do not appear to have an effect on survival. We believe that the variability in practice is a reflection of the lack of standardized treatments for UTUC and underlines the need for multi-institutional studies in this disease.

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Published

2012-12-13

How to Cite

Melcalfe, M., Kassouf, W., Rendon, R., Bell, D., Izawa, J., Chin, J., Kapoor, A., Matsumoto, E., Lattouf, J.-B., Saad, F., Lacombe, L., Fradet, Y., Fairey, A., Jacobson, N.-E., Drachenberg, D., Cagiannos, I., So, A., & Black, P. (2012). Regional differences in practice patterns and associated outcomes for upper tract urothelial carcinoma in Canada. Canadian Urological Association Journal, 6(6), 455–62. https://doi.org/10.5489/cuaj.116

Issue

Vol. 6 No. 6 (2012): CUAJ December

Section

Original Research

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