Processes of Care and the Impact of Surgical Volumes on Cancer-specific Survival: A Population-based Study in Bladder Cancer

Differences between clinical (cT) and pathological tumor (pT) stage occur often after radical cystectomy (RC) for muscle-invasive bladder cancer. In order to evaluate the impact of downstaging on recurrence and survival, we selected patients from a large, contemporary, population-based series of 1,409 patients with MIBC. We included all patients who underwent RC (N=643) and excluded patients who received (neo)adjuvant therapy, those with known metastasis at time of diagnosis, and those with nonurothelial cell tumors. Disease outcomes were defined as recurrence-free survival (RFS) and relative survival (RS), as a good approximation of bladder cancer-specific survival. After applying the exclusion criteria, 375 patients were eligible for analysis. Tumor downstaging was found to be common after RC; in 99 patients (26.4%), tumor downstaging to non-muscle-invasive stages at RC occurred. Hydronephrosis at baseline and positive lymph nodes at RC occurred significantly less often in these patients. In 62 patients, no tumor was left in the cystectomy specimen. pT stage was pT1 in 20 patients and pTis in 17 patients. Patients with tumor downstaging have about a 30% higher RFS and RS compared to those without. Consequently, tumor downstaging is a favorable marker for prognosis after RC.

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Sex Differences of ≥pT1 Bladder Cancer Survival in Austria: A Descriptive, Long-Term, Nation-Wide Analysis Based on 27,773 Patients

Urologia Internationalis ◽

10.1159/000368418 ◽

2015 ◽

Vol 94 (4) ◽

pp. 383-389 ◽

Cited By ~ 8

Author(s):

Thomas Waldhoer ◽

Ingrid Berger ◽

Gerald Haidinger ◽

Nadine Zielonke ◽

Stephan Madersbacher

Keyword(s):

Bladder Cancer ◽

Cancer Survival ◽

Population Based ◽

Cancer Specific Survival ◽

Population Based Study ◽

Age Cohorts ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

The Relationship

Introduction: In recent days, the relationship between gender, tumour stage and survival of bladder cancer has attracted interest. Materials and Methods: The Austrian cancer registry was linked to the national death statistics. All patients with urothelial cancer of the urinary bladder with stages pT1, pT2, pT3 and pT4 diagnosed between 1983 until 2012 were followed for up to 15 years. Overall and cancer-specific mortality were estimated by cumulative incidence. Results: A total of 27,773 patients were analysed. The male:female ratio declined from 3:1 for stage pT1-tumours (n = 16,416) to 2.6:1 for pT2 (n = 6,548), 2.1:1 for pT3 (n = 3,111) and 1.9:1 for pT4 (n = 1,698). The 5 years cumulative overall death rate for pT1 tumours was slightly lower for women (0.31 vs. 0.32; p = 0.016). The opposite was observed for more advanced tumour stages: pT2: women 0.66, men: 0.60 (p = 0.0001); pT3: women 0.76, men 0.72 (p = 0.0004) and for pT4: women 0.90, men 0.85 (p = 0.0001). Cancer-specific survival was identical for pT1-tumours in both sexes, while women had a worse cancer-specific survival in both age cohorts (<70 years and ≥70 years) with higher tumour stages. Conclusions: This population-based study demonstrates that (1) a rise of advanced bladder cancer stages in women and (2) that women with tumour stages >pT1 have a shorter cancer-specific and overall survival.

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Adjuvant Intravesical Bacillus Calmette-Guérin Therapy and Survival Among Elderly Patients With Non–Muscle-Invasive Bladder Cancer

Journal of Oncology Practice ◽

10.1200/jop.2011.000480 ◽

2013 ◽

Vol 9 (2) ◽

pp. 92-98 ◽

Cited By ~ 31

Author(s):

Benjamin A. Spencer ◽

Russell B. McBride ◽

Dawn L. Hershman ◽

Donna Buono ◽

Harry W. Herr ◽

...

Keyword(s):

Bladder Cancer ◽

Older Patients ◽

Large Population ◽

Population Based ◽

Bacillus Calmette Guerin ◽

Muscle Invasive Bladder Cancer ◽

Cancer Specific Survival ◽

Population Based Study ◽

Intravesical Bcg ◽

Muscle Invasive

This large population-based study found improved OS and bladder cancer–specific survival associated with use of adjuvant intravesical BCG among older patients with NMIBC.

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Is there a gender effect in bladder cancer? A population-based study of practice and outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.2927 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 269 ◽

Cited By ~ 13

Author(s):

Francis Michael Patafio ◽

D. Robert Siemens ◽

Xuejiao Wei ◽

Christopher M. Booth

Keyword(s):

Bladder Cancer ◽

Invasive Disease ◽

Population Based ◽

Disease Treatment ◽

Full Cohort ◽

Cancer Specific Survival ◽

Population Based Study ◽

Ontario Cancer Registry ◽

Muscle Invasive ◽

Extent Of Disease

Introduction: The incidence of bladder cancer varies by gender. Whether differences exist between women and men in extent of disease, treatment, and outcome is not well-described. We evaluate gender differences in bladder cancer using a population-based cohort.Methods: Electronic records of treatment were linked to the population- based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy or radical radiotherapy (RT) in Ontario between 1994 and 2008. We compare extent of disease at time of cystectomy, treatment, and outcomes between women and men.Results: In total, 5259 patients with bladder cancer were treated with cystectomy or radical RT; of these, 25% (n = 1296) were women. There was no gender difference in the proportion of patients treated with cystectomy (75% of women [974/1296], 73% of men [2905/3963], p = 0.189). At the time of cystectomy, women were more likely to have muscle-invasive disease (86% [836/974] vs. 80% [2335/2905], p < 0.001), but less likely to have lymph nodes dissected (68% [664/974] vs. 76% [2210/2905], p < 0.001]. Among the 2944 patients with muscle-invasive urothelial carcinoma treated with cystectomy, use of neoadjuvant (5% vs. 4%, p = 0.419) and adjuvant chemotherapy (18% vs. 20%, p = 0.190) did not differ significantly between genders. Five-year cancer-specific survival and overall survival of the full cohort did not differ between women and men (38% vs. 39%, p = 0.522; 33% vs. 33%, p = 0.795).Conclusions: This population-based cohort did not demonstrate any substantial differences in extent of disease, treatment, or outcome between women and men treated with cystectomy or radical RT for bladder cancer.

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The Impact of Multiple Malignancies on Patients with Bladder Carcinoma: A Population-Based Study Using the SEER Database

Advances in Urology ◽

10.1155/2009/406965 ◽

2009 ◽

Vol 2009 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Joshua R. Ehrlich ◽

Michael J. Schwartz ◽

Casey K. Ng ◽

Eric C. Kauffman ◽

Douglas S. Scherr

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Population Based ◽

Survival Advantage ◽

Future Research ◽

Population Based Study ◽

Multiple Malignancies ◽

High Stage ◽

Population Based Registry ◽

The Impact

Purpose. To date, no study has examined a population-based registry to determine the impact of multiple malignancies on survival of bladder cancer patients. Our experience suggests that bladder cancer patients with multiple malignancies may have relatively positive outcomes.Materials & Methods. We utilized data from the Surveillance Epidemiology and End Results (SEERs) database to examine survival between patients with only bladder cancer (BO) and with bladder cancer and additional cancer(s) antecedent (AB), subsequent (BS), or antecedent and subsequent to bladder cancer (ABS).Results. Analyses demonstrated diminished survival among AB and ABS cohorts. However, when cohorts were substratified by stage, patients in the high-stage BS cohort appeared to have a survival advantage over high-stage BO patients.Conclusions. Bladder cancer patients with multiple malignancies have diminished survival. The survival advantage of high-stage BS patients is likely a statistical phenomenon. Such findings are important to shape future research and to improve our understanding of patients with multiple malignancies.

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