End results for urologic cancers. Trends and interhospital differences

Long-term results for treatment of several urologic cancers have improved in recent years. Data from the studies of the American College of Surgeons and from the National Cancer Institute document these trends. For prostate cancer, the 5-year survival rate, for all stages, increased during the 1970s. Although seminomas of the testes have had high survival rates for several years, nonseminomas have had much poorer outcomes. Data from the 1985 survey of the American College of Surgeons indicate that the prognosis for nonseminoma tumors of the testes is now much improved. Analyses have been conducted to assess the influence of patient and tumor characteristics on end results. Age, race, stage and, histologic type continue to be the major determinants of survival. The role of treatment setting also has been studied. The data reveal that outcomes for similar patients differ little among hospitals which meet approval standards for operation of a cancer program. Issues regarding validity of the observations and the influence of "stage migration" on the end results have been examined. The distribution of survival improvements across stages, and, the correlation of changing survival with improved patterns of care may suggest that the improvements in urologic cancer outcomes are more than statistical artifacts.