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

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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–IV bladder cancer from 1 January 2007 to 31 December 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database. We used multivariable regression analyses to identify factors predicting the 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 versus 2007 (OR 2.32, 95% CI 1.90–2.83, p < 0.001), greater percentage of college education ≥36.3 versus <21.3% (OR 1.23, 95% CI 1.04–1.44, p = 0.013), Midwest versus West (OR 1.64, 95% CI 1.39–1.94, p < 0.001), and more advanced clinical stage III versus I (OR 29.1, 95% CI 23.9–35.3, p < 0.001) were 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.

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References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5

    Article  PubMed  Google Scholar 

  2. Clark PE, Agarwal N, Biagioli MC et al (2013) Bladder cancer. J Natl Compr Cancer Netw 11:446

    Article  CAS  Google Scholar 

  3. Williams SB, Huo J, Chamie K et al (2016) Underutilization of radical cystectomy among patients diagnosed with clinical stage T2 muscle-invasive bladder cancer. Eur Urol Focus. doi:10.1016/j.euf.2016.04.008

    Google Scholar 

  4. Gore JL, Litwin MS, Lai J et al (2010) Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst 102:802

    Article  PubMed  PubMed Central  Google Scholar 

  5. Grossman HB, Natale RB, Tangen CM et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349:859

    Article  CAS  PubMed  Google Scholar 

  6. Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666

    Article  CAS  PubMed  Google Scholar 

  7. Zehnder P, Studer UE, Skinner EC et al (2013) Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades. BJU Int 112:E51

    Article  PubMed  Google Scholar 

  8. Mallin K, David KA, Carroll PR et al (2011) Transitional cell carcinoma of the bladder: racial and gender disparities in survival (1993 to 2002), stage and grade (1993 to 2007). J Urol 185:1631

    Article  PubMed  Google Scholar 

  9. Barocas DA, Alvarez J, Koyama T et al (2014) Racial variation in the quality of surgical care for bladder cancer. Cancer 120:1018

    Article  PubMed  Google Scholar 

  10. Walker GV, Grant SR, Guadagnolo BA et al (2014) Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol 32:3118

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hutchins VA, Samuels MB, Lively AM (2013) Analyzing the affordable care act: essential health benefits and implications for oncology. J Oncol Pract 9:73

    Article  PubMed  PubMed Central  Google Scholar 

  12. Weir HK, Johnson CJ, Mariotto AB et al (2014) Evaluation of North American Association of Central Cancer Registries’ (NAACCR) data for use in population-based cancer survival studies. J Natl Cancer Inst Monogr 2014:198

    Article  PubMed  PubMed Central  Google Scholar 

  13. Area Health Resource File (2017) Health Resources and Services Administration. AHRF [Internet]. HRSA, Rockville. http://ahrf.hrsa.gov/. Accessed 4 Jan 2017

  14. Leow JJ, Reese S, Trinh QD et al (2015) Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis. BJU Int 115:713

    Article  PubMed  Google Scholar 

  15. Kim LK, Swaminathan RV, Minutello RM et al (2015) Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007–2011. Catheter Cardiovasc Interv 86:864

    Article  PubMed  Google Scholar 

  16. Birkmeyer JD, Siewers AE, Marth NJ et al (2003) Regionalization of high-risk surgery and implications for patient travel times. J Am Med Assoc 290:2703

    Article  CAS  Google Scholar 

  17. Booth CM, Siemens DR, Li G et al (2014) Perioperative chemotherapy for muscle-invasive bladder cancer: a population-based outcomes study. Cancer 120:1630

    Article  PubMed  Google Scholar 

  18. Froehner M, Novotny V, Heberling U et al (2014) Relationship of the number of removed lymph nodes to bladder cancer and competing mortality after radical cystectomy. Eur Urol 66:987

    Article  PubMed  Google Scholar 

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Acknowledgments

This study used the SEER database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) program tumor registries in the creation of the SEER database. This work was supported by the Duncan Family Institute. We would also like to thank Yessica Chevez and Deborah Burkley for their efforts in preparing this manuscript for publication.

Disclosure

All authors have no financial interests to disclose.

Funding

This study was funded by the Institute for Translational Sciences at the University of Texas Medical Branch and a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health (SBW).

Author information

Authors and Affiliations

  1. The Division of Urology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA

    Stephen B. Williams & Christopher D. Kosarek

  2. The Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA

    Jinhai Huo & Sharon H. Giordano

  3. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Karim Chamie

  4. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Selwyn O. Rogers Jr.

  5. School of Public Health, Washington University, St. Louis, MO, USA

    Michele A. Williams

  6. Department of Urology, Case Western Reserve Medical Center, Cleveland, OH, USA

    Simon P. Kim

  7. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ashish M. Kamat

Authors
  1. Stephen B. Williams
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  2. Jinhai Huo
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  3. Christopher D. Kosarek
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  4. Karim Chamie
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  5. Selwyn O. Rogers Jr.
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  6. Michele A. Williams
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  7. Sharon H. Giordano
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  8. Simon P. Kim
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  9. Ashish M. Kamat
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Contributions

SB Williams participated in protocol/project development, data collection or management, manuscript writing/editing, and other supervision work. J Huo participated in data collection or management, data analysis, and manuscript writing/editing. C Kosarek, K Chamie, S Rogers, M Williams, S Kim, and P Nguyen participated in manuscript writing/editing. S Giordano and A Kamat participated in manuscript writing/editing and other supervision work.

Corresponding author

Correspondence to Stephen B. Williams.

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Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in concordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Conflict of interest

All the authors declare they have no conflict of interest.

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Williams, S.B., Huo, J., Kosarek, C.D. et al. Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer. Cancer Causes Control 28, 755–766 (2017). https://doi.org/10.1007/s10552-017-0902-2

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  • DOI: https://doi.org/10.1007/s10552-017-0902-2

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