Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul;28(7):755-766.
doi: 10.1007/s10552-017-0902-2. Epub 2017 May 5.

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

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

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

Stephen B Williams et al. Cancer Causes Control. 2017 Jul.

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.

Keywords: Bladder cancer; Disparities; Lymph node dissection; Radical cystectomy; Utilization.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: All authors declare they have no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier curves of overall survival in patients with bladder cancer treated with and without radical cystectomy
Figure 1
Figure 1
Kaplan-Meier curves of overall survival in patients with bladder cancer treated with and without radical cystectomy
Figure 2
Figure 2
Kaplan-Meier curves of bladder cancer-specific survival in patients with bladder cancer treated with and without radical cystectomy.
Figure 2
Figure 2
Kaplan-Meier curves of bladder cancer-specific survival in patients with bladder cancer treated with and without radical cystectomy.
See this image and copyright information in PMC

Comment in

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5. - PubMed
    1. Clark PE, Agarwal N, Biagioli MC, et al. Bladder cancer. J Natl Compr Canc Netw. 2013;11:446. - PubMed
    1. Williams SB, Huo J, Chamie K, et al. Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer. European Urology Focus. 2016 online. - PubMed
    1. Gore JL, Litwin MS, Lai J, et al. Use of radical cystectomy for patients with invasive bladder cancer. J Natl Cancer Inst. 2010;102:802. - PMC - PubMed
    1. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349:859. - PubMed