The impact of fellowship training on pathological outcomes following radical prostatectomy: a population based analysis.
The impact of fellowship training on pathological outcomes following radical prostatectomy: a population based analysis.
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DOI：
10.1186/1471-2490-14-82
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发表时间：
2014-10-23
期刊：
影响因子：
2
通讯作者：
Quon H
中科院分区：
文献类型：
--
作者：
Nayak JG;Drachenberg DE;Mau E;Suderman D;Bucher O;Lambert P;Quon H
根治性前列腺切除术（RP）是前列腺癌（PCa）的常见治疗方法。发病率，死亡率和病理结果可能是上级的学术机构。一种解释可能是学术机构内接受过肿瘤学研究金培训的泌尿科医生的参与。检查病理结果的文献通常缺乏个体外科医生的数据。本研究的目的是比较经过研究员培训和未经研究员培训的泌尿科医生在RP后的病理结果。对2003年至2008年诊断为PCa的男性患者进行基于人群的回顾性病历审查，大多数患者接受开放性RP治疗（>99%）。病理结果之间进行了比较肿瘤学奖学金培训的学术（FTA），非奖学金培训的学术（NFTA）和非学术（NA）泌尿科医生。采用多变量logistic回归分析与病理结果的关系。83.1%的合格患者被纳入我们的分析，共1075例患者。在多变量分析中，外科医生组是手术切缘阳性（PSM）的独立预测因素（p < 0.0001）。与FTA泌尿科医生相比，NFTA和NA泌尿科医生更可能患有PSM（OR 2.50; 95% CI：1.44 - 4.35和OR 2.10; 95% CI：1.53 - 2.88）。然而，NFTA和NA泌尿科医生之间的PSM比例不显著（p = 0.492）。此外，病理分期（p = 0.0004）、Gleason总和（p < 0.0001）和外科手术量（p = 0.017）与PSM相关。局限性包括回顾性设计以及缺乏临床和功能结局。在这个基于人群的队列中，接受过泌尿肿瘤学研究员培训的外科医生的PSM发生率显著低于未接受过研究员培训的外科医生。这项研究表明了外科医生相关变量对病理结果的重要性，并强调了额外的泌尿肿瘤学奖学金培训的价值。
Radical prostatectomy (RP) is a common treatment for prostate cancer (PCa). Morbidity, mortality and pathological outcomes may be superior in academic institutions. One explanation may be the involvement of oncology fellowship trained urologists within academic institutions. The literature examining pathological outcomes often lacks individual surgeon data. The objective of this study was to compare pathological outcomes following RP between fellowship trained and non-fellowship trained urologists. Population-based, retrospective chart review of men diagnosed with PCa between 2003 and 2008, the majority treated with open approach RP (>99%). Pathological outcomes were compared between oncology fellowship trained academic (FTA), non-fellowship trained academic (NFTA) and non-academic (NA) urologists. Relationships with pathological outcomes were examined utilizing multivariable logistic regression. 83.1% of eligible patients were included in our analysis resulting in 1075 patients. In multivariable analysis, surgeon group was an independent predictor of positive surgical margin (PSM) (p < 0.0001). NFTA and NA urologists were more likely to have PSM compared to FTA urologists (OR 2.50; 95% CI: 1.44 - 4.35 and OR 2.10; 95% CI: 1.53 - 2.88, respectively). However, the proportion of PSM between NFTA and NA urologists was not significant (p = 0.492). In addition, pathological stage (p = 0.0004), Gleason sum (p < 0.0001), and surgeon volume (p = 0.017) were associated with PSM. Limitations include retrospective design and lack of clinical and functional outcomes. Uro-oncology fellowship trained surgeons had significantly lower rates of PSM than non-fellowship trained surgeons in this population based cohort. This study demonstrates the importance of surgeon-related variables on pathological outcomes and highlights the value of additional urologic oncology fellowship training.
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