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

Stephen B. 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 journalArticlepeer-review

11 Scopus citations


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)755-766
Number of pages12
JournalCancer Causes and Control
Issue number7
StatePublished - Jul 1 2017
Externally publishedYes


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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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