Survival differences among patients with bladder cancer according to sex

Critical evaluation of radical cystectomy use and delay to treatment

Stephen B. Williams, Jinhai Huo, Tamer J. Dafashy, Cameron K. Ghaffary, Jacques G. Baillargeon, Edwin E. Morales, Simon P. Kim, Yong Fang Kuo, Eduardo Orihuela, Douglas S. Tyler, Stephen J. Freedland, Ashish M. Kamat

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Sex differences in bladder cancer survival are well known. However, the effect of type of treatment, timing to surgery when rendered, and survival outcomes according to sex have not been extensively examined. Given the relatively low incidence of bladder cancer in females, large multicenter and population-based studies are required to elucidate sex differences in survival. In this study, we sought to characterize the effect of use and timing of radical cystectomy (RC) according to sex and survival outcomes. Methods: A total of 9,907 patients aged 66 years or older diagnosed with clinical stage II to IV N0M0 bladder cancer from January 1, 2001 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare data were analyzed. We used multivariable regression analyses to identify factors predicting the use and delay of RC. Cox proportional hazards models were used to analyze survival outcomes. Results: Of the 9,907 patients diagnosed with bladder cancer, 3,256 (32.9%) were females. Women were significantly more likely to undergo RC across all stages compared to their male counterparts (stage II: relative risk [RR] = 1.48, 95% CI: 1.33-1.65, P<0.001; stage III: RR = 1.24, 95% CI: 1.13-1.37, P<0.001; and stage IV: RR = 1.33, 95% CI: 1.19-1.49, P<0.001). Moreover, there was no significant difference in delay to RC according to sex across all clinical stages. Using propensity score matching, women had worse overall (hazard ratio = 1.07; CI: 1.01-1.14; P = 0.024), and worse cancer-specific survival (hazard ratio = 1.26; CI: 1.17-1.36, P<0.001) than men. Conclusion: Sex differences persist with women who are significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Mar 6 2017

Fingerprint

Cystectomy
Urinary Bladder Neoplasms
Survival
Sex Characteristics
Therapeutics
Propensity Score
Survival Analysis
Medicare
Proportional Hazards Models
Epidemiology
Regression Analysis
Incidence
Population
Neoplasms

Keywords

  • Bladder cancer
  • Differences
  • Radical cystectomy
  • Sex
  • Utilization

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Survival differences among patients with bladder cancer according to sex : Critical evaluation of radical cystectomy use and delay to treatment. / Williams, Stephen B.; Huo, Jinhai; Dafashy, Tamer J.; Ghaffary, Cameron K.; Baillargeon, Jacques G.; Morales, Edwin E.; Kim, Simon P.; Kuo, Yong Fang; Orihuela, Eduardo; Tyler, Douglas S.; Freedland, Stephen J.; Kamat, Ashish M.

In: Urologic Oncology: Seminars and Original Investigations, 06.03.2017.

Research output: Contribution to journalArticle

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title = "Survival differences among patients with bladder cancer according to sex: Critical evaluation of radical cystectomy use and delay to treatment",
abstract = "Objective: Sex differences in bladder cancer survival are well known. However, the effect of type of treatment, timing to surgery when rendered, and survival outcomes according to sex have not been extensively examined. Given the relatively low incidence of bladder cancer in females, large multicenter and population-based studies are required to elucidate sex differences in survival. In this study, we sought to characterize the effect of use and timing of radical cystectomy (RC) according to sex and survival outcomes. Methods: A total of 9,907 patients aged 66 years or older diagnosed with clinical stage II to IV N0M0 bladder cancer from January 1, 2001 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare data were analyzed. We used multivariable regression analyses to identify factors predicting the use and delay of RC. Cox proportional hazards models were used to analyze survival outcomes. Results: Of the 9,907 patients diagnosed with bladder cancer, 3,256 (32.9{\%}) were females. Women were significantly more likely to undergo RC across all stages compared to their male counterparts (stage II: relative risk [RR] = 1.48, 95{\%} CI: 1.33-1.65, P<0.001; stage III: RR = 1.24, 95{\%} CI: 1.13-1.37, P<0.001; and stage IV: RR = 1.33, 95{\%} CI: 1.19-1.49, P<0.001). Moreover, there was no significant difference in delay to RC according to sex across all clinical stages. Using propensity score matching, women had worse overall (hazard ratio = 1.07; CI: 1.01-1.14; P = 0.024), and worse cancer-specific survival (hazard ratio = 1.26; CI: 1.17-1.36, P<0.001) than men. Conclusion: Sex differences persist with women who are significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.",
keywords = "Bladder cancer, Differences, Radical cystectomy, Sex, Utilization",
author = "Williams, {Stephen B.} and Jinhai Huo and Dafashy, {Tamer J.} and Ghaffary, {Cameron K.} and Baillargeon, {Jacques G.} and Morales, {Edwin E.} and Kim, {Simon P.} and Kuo, {Yong Fang} and Eduardo Orihuela and Tyler, {Douglas S.} and Freedland, {Stephen J.} and Kamat, {Ashish M.}",
year = "2017",
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doi = "10.1016/j.urolonc.2017.05.022",
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T2 - Critical evaluation of radical cystectomy use and delay to treatment

AU - Williams, Stephen B.

AU - Huo, Jinhai

AU - Dafashy, Tamer J.

AU - Ghaffary, Cameron K.

AU - Baillargeon, Jacques G.

AU - Morales, Edwin E.

AU - Kim, Simon P.

AU - Kuo, Yong Fang

AU - Orihuela, Eduardo

AU - Tyler, Douglas S.

AU - Freedland, Stephen J.

AU - Kamat, Ashish M.

PY - 2017/3/6

Y1 - 2017/3/6

N2 - Objective: Sex differences in bladder cancer survival are well known. However, the effect of type of treatment, timing to surgery when rendered, and survival outcomes according to sex have not been extensively examined. Given the relatively low incidence of bladder cancer in females, large multicenter and population-based studies are required to elucidate sex differences in survival. In this study, we sought to characterize the effect of use and timing of radical cystectomy (RC) according to sex and survival outcomes. Methods: A total of 9,907 patients aged 66 years or older diagnosed with clinical stage II to IV N0M0 bladder cancer from January 1, 2001 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare data were analyzed. We used multivariable regression analyses to identify factors predicting the use and delay of RC. Cox proportional hazards models were used to analyze survival outcomes. Results: Of the 9,907 patients diagnosed with bladder cancer, 3,256 (32.9%) were females. Women were significantly more likely to undergo RC across all stages compared to their male counterparts (stage II: relative risk [RR] = 1.48, 95% CI: 1.33-1.65, P<0.001; stage III: RR = 1.24, 95% CI: 1.13-1.37, P<0.001; and stage IV: RR = 1.33, 95% CI: 1.19-1.49, P<0.001). Moreover, there was no significant difference in delay to RC according to sex across all clinical stages. Using propensity score matching, women had worse overall (hazard ratio = 1.07; CI: 1.01-1.14; P = 0.024), and worse cancer-specific survival (hazard ratio = 1.26; CI: 1.17-1.36, P<0.001) than men. Conclusion: Sex differences persist with women who are significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.

AB - Objective: Sex differences in bladder cancer survival are well known. However, the effect of type of treatment, timing to surgery when rendered, and survival outcomes according to sex have not been extensively examined. Given the relatively low incidence of bladder cancer in females, large multicenter and population-based studies are required to elucidate sex differences in survival. In this study, we sought to characterize the effect of use and timing of radical cystectomy (RC) according to sex and survival outcomes. Methods: A total of 9,907 patients aged 66 years or older diagnosed with clinical stage II to IV N0M0 bladder cancer from January 1, 2001 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare data were analyzed. We used multivariable regression analyses to identify factors predicting the use and delay of RC. Cox proportional hazards models were used to analyze survival outcomes. Results: Of the 9,907 patients diagnosed with bladder cancer, 3,256 (32.9%) were females. Women were significantly more likely to undergo RC across all stages compared to their male counterparts (stage II: relative risk [RR] = 1.48, 95% CI: 1.33-1.65, P<0.001; stage III: RR = 1.24, 95% CI: 1.13-1.37, P<0.001; and stage IV: RR = 1.33, 95% CI: 1.19-1.49, P<0.001). Moreover, there was no significant difference in delay to RC according to sex across all clinical stages. Using propensity score matching, women had worse overall (hazard ratio = 1.07; CI: 1.01-1.14; P = 0.024), and worse cancer-specific survival (hazard ratio = 1.26; CI: 1.17-1.36, P<0.001) than men. Conclusion: Sex differences persist with women who are significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.

KW - Bladder cancer

KW - Differences

KW - Radical cystectomy

KW - Sex

KW - Utilization

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