MP58-18 OUTCOME OF METASTATIC UROTHELIAL CARCINOMA IN GC ERA: PROGNOSTIC FACTORS FROM REAL-WORLD CLINICAL PRACTICE IN JAPAN

INTRODUCTION AND OBJECTIVES: Surgeonand hospitalcase volume are identified as factors related with outcomes of surgical procedures. Radical cystectomy (RC), due to its major impact on the patient, might substantially benefit from centralization if this assumption were true. We aim to test this hypothesis in Spain, a country in which no lower limit nor centralization for radical cystectomy exists. METHODS: We performed a retrospective cohort review of patients undergoing RC in Spain during 2011 and 2012, accessing data from inpatient discharge forms (CMBD) of every patient operated on of radical cystectomy. CMBD is a mandatory file that is submitted to the Ministry of Health and provides information on patient’s demographics as well as morbidity and cause of discharge including death. Hospitals were stratified into volume quartiles depending on their 2-year cumulative cystectomy volume (very lowvolume 58). Hospitals were also categorized according to their size in beds and teaching facilities. A comparison with data in the literature was made. RESULTS: We analyzed 5,594 RCs in 266 centers of Spain during 2011 and 2012 (2,701 RCs in 2011 and 2,893 RCs in 2012). Mean age was 66.5 9.8 years and 84.7% were males. Mean hospital stay was 20.7 16.6 days. Mortality rate at 30, 60 and 90 days was 2.8%, 4.7% and 5.9%, respectively. 90-day mortality rate for very-low, low, medium and high-volume centers was 5.9%, 5.9%, 7% and 5.1%, respectively (p1⁄40.2). Hospital size and teaching facilities were not associated with mortality. A statistically significant difference was noted in the complications and readmission rate. These results compare favorably with reported multicenter series in the literature with 90-day mortality rate ranging from 4.2 to 7.9%. CONCLUSIONS: Our data do not support an urgent need for regionalization of radical cystectomy in our country. However, initiatives to improve surgical outcomes of radical cystectomy within individual national setting should be explored.