Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer

Abstract

Purpose Radical cystectomy is a surgical treatment for recurrent non-muscle invasive and muscle-invasive bladder cancer, however, many patients may not receive this treatment. Methods A total of 27,578 patients diagnosed with clinical stage I to IV bladder cancer from January 1, 2007 to December 31, 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database. We used multivariable regression analyses to identify factors predicting use of radical cystectomy and pelvic lymph node dissection. Cox proportional hazards models were used to analyze survival outcomes. Results A total of 1,693 (6.1%) patients with bladder cancer underwent radical cystectomy. Most patients (92.4%) who underwent radical cystectomy also underwent pelvic lymph node dissection. When compared with white patients, non-Hispanic blacks were less likely to undergo a radical cystectomy (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.64–0.96, p = 0.019). Moreover, recent year of surgery 2013 vs. 2007 (OR 2.32, 95% CI 1.90–2.83, p < 0.001), greater percentage of college education ≥ 36.3% vs. <21.3% (OR 1.23, 95% CI 1.04–1.44, p =0.013), Midwest vs. West (OR 1.64, 95% CI 1.39–1.94, p<0.001) and more advanced clinical stage III vs. I (OR 29.1, 95% CI 23.9–35.3, p<0.001) was associated with increased use of radical cystectomy. Overall survival was improved for patients who underwent radical cystectomy compared with those who did not undergo a radical cystectomy (hazard ratio 0.88, 95% CI 0.80–0.97, p = 0.008). Conclusion There is significant underutilization of radical cystectomy in patients across all age groups diagnosed with bladder cancer, especially among older, non-Hispanic black patients.

Combination role of DAPK methylation in urinary sediment and B ultrasound in evaluating follow-up of urinary bladder cancer

“…However, we should also bear in mind that the clinical research shall be authentic and rigorous, therefore, more studies involving a larger number of included patients shall be required. In addition, as racial/ethnic differences may be a risk factor that influences therapy surveillance [21,22], we should also consider those racial/ethnic disparities when choosing optimal diagnostic tools for patients with different ethnic background.…”

High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients

“…In a SEER study that evaluated 6.737 patients in the USA with stage II disease (non-metastatic, muscle-invasive bladder cancer), only 8.3% underwent radical cystectomy (8). The odds of an octogenarian to undergo radical cystectomy in the USA is five-times lower than a young patient (8). Hispanic origin, Afro-American origin, and lower scholar level patients are also less treated properly when they have muscle-invasive bladder cancer (8).…”

“…However, if we analyze data carefully, the guideline recommendations are rarely followed. In a SEER study that evaluated 6.737 patients in the USA with stage II disease (non-metastatic, muscle-invasive bladder cancer), only 8.3% underwent radical cystectomy ( 8 ). The odds of an octogenarian to undergo radical cystectomy in the USA is five-times lower than a young patient ( 8 ).…”

“…The odds of an octogenarian to undergo radical cystectomy in the USA is five-times lower than a young patient ( 8 ). Hispanic origin, Afro-American origin, and lower scholar level patients are also less treated properly when they have muscle-invasive bladder cancer ( 8 ). According to a very interesting study that evaluated 27,578 patients from the SEER, only 6% of patients with muscle-invasive bladder cancer (pT2-pT4) in the USA underwent radical cystectomy between 2007 and 2013 ( 8 ).…”

“…Hispanic origin, Afro-American origin, and lower scholar level patients are also less treated properly when they have muscle-invasive bladder cancer ( 8 ). According to a very interesting study that evaluated 27,578 patients from the SEER, only 6% of patients with muscle-invasive bladder cancer (pT2-pT4) in the USA underwent radical cystectomy between 2007 and 2013 ( 8 ). Less than 19% of patients with pT2 disease in the USA undergo radical cystectomy ( 9 ).…”