Short‐ and long‐term survival has improved after radical cystectomy for bladder cancer in Québec during the years 2000‐2015

Abstract

Background and Objectives We evaluated the short‐ and long‐term outcome in bladder cancer (BC) patients treated with radical cystectomy (RC) in Québec (Canada). Methods Data were collected from provincial registries on all BC patients who underwent RC in Québec province in 2000‐2015. Outcomes were hospitalization rates and survival. Survival analyses were conducted using log‐rank tests and Cox proportional hazards models. Results In total, 4450 patients were included in our analysis. RC was increasingly conducted by higher‐volume surgeons in larger, higher‐volume, academic hospitals. Comparing patients treated in 2010‐2015 to 2000‐2009, recently treated patients had shorter postoperative hospital stays (absolute difference, 0.9 days, P < 0.001) but also a higher readmission rate (25.0% vs 21.1% in the 30 days following discharge, P = 0.003). Overall (5‐year rates 50.9% vs 42.7%, P < 0.001) and BC‐specific survival (61.3% vs 55.5%, P < 0.001) had significantly improved. In multivariable analyses, overall survival was significantly better in recently treated patients (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.60‐0.73), younger patients (HR, 1.16; 95% CI, 1.14‐1.19), patients residing closer to the hospital (HR, 1.03; 95% CI, 1.01‐1.06), and patients treated by high‐volume surgeons (HR, 0.88; 95% CI, 0.82‐0.94). Conclusions Survival in BC patients after RC has improved in recent years. Other predictors for survival are younger age, shorter distance between patients' residences and hospitals, and higher surgeon's RC loads.

Statins are Associated with Reduced Overall and Cancer-Specific Mortality in Patients Undergoing Radical Cystectomy for Bladder Cancer

“…It follows international guidelines such as the Declaration of Helsinki. Our cohort consists of all patients who underwent RC for bladder cancer in Quebec between 2000 and 2015, as registered by the universal health care provider provincial administrative databases [15]. Quebec administrative agencies collect data on all medical procedures performed in public medical centers across Quebec, all hospital and emergency room admissions, intensive care unit stays, all medication prescribed in Quebec outpatient pharmacies to patients covered by the Public Prescription Drug Insurance Plan (universal coverage), and all deaths in Quebec (including date and cause of death).…”

“…Selection of our cohort has been described previously [15]. In summary, after several validity checks, we included all patients who had a RC conducted by a urologist in a public hospital in the province of Quebec between January 1st, 2000 and December 31st, 2015.…”

“…Patients could have an index between two (all patients had a solid tumor, which is two points) and 33. Year of surgery was included as a binary categorical variable, as we previously observed a difference in survival between patients treated in 2000-2009 and those treated in 2010-2015 [15]. We used Google maps to calculate the driving distance between the center of a patient's postal code and the hospital of surgery (continuous variable) [15].…”

“…Overall survival was calculated as the time between RC and death or last follow-up. The definition of bladder cancer-specific deaths has been prescribed previously [15]. In brief, all death causes with ICD-10 codes for genitourinary cancers were included, unless the diagnosis specified a different genitourinary cancer (e.g., prostate cancer).…”

The use of perioperative chemotherapy in patients undergoing radical cystectomy for bladder cancer in Quebec (Canada), 2000-2016

“…During a rigorous selection process, we excluded 492 patients who had radical cystectomy for other indications than bladder cancer or who had their cystectomy performed by other surgeons than urologists, as previously described. 15 All patient data were collected from two years before the radical cystectomy until death or the last day the patient was known to be alive before January 1 st , 2017. The collected data consisted of all medical procedures performed in public hospitals, all hospital and emergency room admissions, intensive care unit stays, all prescribed medication bought in outpatient pharmacies by individuals covered by the Public Prescription Drug Insurance Plan (universal health coverage), and all deaths (including date and cause of death) in Quebec.…”