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

Stephen Williams, Jinhai Huo, Christopher D. Kosarek, Karim Chamie, Selwyn O. Rogers, Michele A. Williams, Sharon H. Giordano, Simon P. Kim, Ashish M. Kamat

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)1-12
    Number of pages12
    JournalCancer Causes and Control
    DOIs
    StateAccepted/In press - May 5 2017

    Fingerprint

    Cystectomy
    Urinary Bladder Neoplasms
    Confidence Intervals
    Population
    Odds Ratio
    Lymph Node Excision
    Survival Analysis
    Proportional Hazards Models
    Registries
    Epidemiology
    Age Groups
    Regression Analysis
    Databases
    Education
    Muscles
    Survival
    Therapeutics

    Keywords

    • Bladder cancer
    • Disparities
    • Lymph node dissection
    • Radical cystectomy
    • Utilization

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

    Cite this

    Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer. / Williams, Stephen; Huo, Jinhai; Kosarek, Christopher D.; Chamie, Karim; Rogers, Selwyn O.; Williams, Michele A.; Giordano, Sharon H.; Kim, Simon P.; Kamat, Ashish M.

    In: Cancer Causes and Control, 05.05.2017, p. 1-12.

    Research output: Contribution to journalArticle

    Williams, Stephen ; Huo, Jinhai ; Kosarek, Christopher D. ; Chamie, Karim ; Rogers, Selwyn O. ; Williams, Michele A. ; Giordano, Sharon H. ; Kim, Simon P. ; Kamat, Ashish M. / Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer. In: Cancer Causes and Control. 2017 ; pp. 1-12.
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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.",
    keywords = "Bladder cancer, Disparities, Lymph node dissection, Radical cystectomy, Utilization",
    author = "Stephen Williams and Jinhai Huo and Kosarek, {Christopher D.} and Karim Chamie and Rogers, {Selwyn O.} and Williams, {Michele A.} and Giordano, {Sharon H.} and Kim, {Simon P.} and Kamat, {Ashish M.}",
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    T1 - Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer

    AU - Williams, Stephen

    AU - Huo, Jinhai

    AU - Kosarek, Christopher D.

    AU - Chamie, Karim

    AU - Rogers, Selwyn O.

    AU - Williams, Michele A.

    AU - Giordano, Sharon H.

    AU - Kim, Simon P.

    AU - Kamat, Ashish M.

    PY - 2017/5/5

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    N2 - 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.

    AB - 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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    KW - Disparities

    KW - Lymph node dissection

    KW - Radical cystectomy

    KW - Utilization

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