Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer

Stephen Williams, Jinhai Huo, Karim Chamie, Jim C. Hu, Sharon H. Giordano, Karen E. Hoffman, Colin P.N. Dinney, Ashish M. Kamat, Ya Chen Tina Shih

    Research output: Contribution to journalArticle

    19 Citations (Scopus)

    Abstract

    Background Radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer (MIBC). Objective We sought to identify population-based factors predicting the use of radical cystectomy. Design, setting, and patients Analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data for 3922 patients aged ≥66 yr diagnosed with clinical stage T2 MIBC from January 1, 2002 to December 31, 2011. Outcome measurements and statistical analysis We used univariate and multivariable regression analyses to identify factors predicting the use of radical cystectomy. Cox proportional hazards models were used to analyze survival outcomes. Results and limitations A total of 740 (18.9%) patients with MIBC underwent radical cystectomy. Older age at diagnosis (>80 vs 65–69 yr, odds ratio [OR] 0.15, 95% confidence interval [CI] 0.11–0.19; p < 0.001) and higher comorbidity (Charlson comorbidity index 3+ vs 0, OR 0.41, 95% CI 0.29–0.57; p < 0.001) were associated with lower use of radical cystectomy. Moreover, non-Hispanic black patients were less likely than white patients to undergo radical cystectomy (OR 0.62, 95% CI 0.40–0.96; p = 0.032) and pelvic lymph node dissection (OR 0.65, 95% CI 0.42–1.02; p = 0.058). Overall survival was better for patients who underwent radical cystectomy alone (hazard ratio [HR] 0.70, 95% CI 0.56–0.88; p = 0.002) and with lymph node dissection (HR 0.45, 95% CI 0.40–0.51; p < 0.001). Limitations include the limited ability of retrospective analysis to demonstrate causality. Conclusions There is significant underutilization of radical cystectomy among patients diagnosed with MIBC, especially among older patients with significant comorbidities and non-Hispanic black patients. Patient summary Despite guideline recommendations, there is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer, especially for non-Hispanic black patients and older patients with significant comorbidities. There is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer in the USA, especially among non-Hispanic black patients and older patients with significant comorbidities. Further research is needed to qualitatively describe the factors that drive the decision to undergo surgery and improve rates of radical cystectomy in patients with bladder cancer.

    Original languageEnglish (US)
    Pages (from-to)258-264
    Number of pages7
    JournalEuropean Urology Focus
    Volume3
    Issue number2-3
    DOIs
    StatePublished - Apr 1 2017

    Fingerprint

    Cystectomy
    Urinary Bladder Neoplasms
    Muscles
    Comorbidity
    Confidence Intervals
    Odds Ratio
    Lymph Node Excision
    Survival Analysis
    Medicare
    Proportional Hazards Models

    Keywords

    • Bladder cancer
    • Disparities
    • Radical cystectomy
    • Utilization

    ASJC Scopus subject areas

    • Urology

    Cite this

    Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer. / Williams, Stephen; Huo, Jinhai; Chamie, Karim; Hu, Jim C.; Giordano, Sharon H.; Hoffman, Karen E.; Dinney, Colin P.N.; Kamat, Ashish M.; Shih, Ya Chen Tina.

    In: European Urology Focus, Vol. 3, No. 2-3, 01.04.2017, p. 258-264.

    Research output: Contribution to journalArticle

    Williams, S, Huo, J, Chamie, K, Hu, JC, Giordano, SH, Hoffman, KE, Dinney, CPN, Kamat, AM & Shih, YCT 2017, 'Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer', European Urology Focus, vol. 3, no. 2-3, pp. 258-264. https://doi.org/10.1016/j.euf.2016.04.008
    Williams, Stephen ; Huo, Jinhai ; Chamie, Karim ; Hu, Jim C. ; Giordano, Sharon H. ; Hoffman, Karen E. ; Dinney, Colin P.N. ; Kamat, Ashish M. ; Shih, Ya Chen Tina. / Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer. In: European Urology Focus. 2017 ; Vol. 3, No. 2-3. pp. 258-264.
    @article{1ced8022948f4871b3f259e8130e6e30,
    title = "Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer",
    abstract = "Background Radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer (MIBC). Objective We sought to identify population-based factors predicting the use of radical cystectomy. Design, setting, and patients Analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data for 3922 patients aged ≥66 yr diagnosed with clinical stage T2 MIBC from January 1, 2002 to December 31, 2011. Outcome measurements and statistical analysis We used univariate and multivariable regression analyses to identify factors predicting the use of radical cystectomy. Cox proportional hazards models were used to analyze survival outcomes. Results and limitations A total of 740 (18.9{\%}) patients with MIBC underwent radical cystectomy. Older age at diagnosis (>80 vs 65–69 yr, odds ratio [OR] 0.15, 95{\%} confidence interval [CI] 0.11–0.19; p < 0.001) and higher comorbidity (Charlson comorbidity index 3+ vs 0, OR 0.41, 95{\%} CI 0.29–0.57; p < 0.001) were associated with lower use of radical cystectomy. Moreover, non-Hispanic black patients were less likely than white patients to undergo radical cystectomy (OR 0.62, 95{\%} CI 0.40–0.96; p = 0.032) and pelvic lymph node dissection (OR 0.65, 95{\%} CI 0.42–1.02; p = 0.058). Overall survival was better for patients who underwent radical cystectomy alone (hazard ratio [HR] 0.70, 95{\%} CI 0.56–0.88; p = 0.002) and with lymph node dissection (HR 0.45, 95{\%} CI 0.40–0.51; p < 0.001). Limitations include the limited ability of retrospective analysis to demonstrate causality. Conclusions There is significant underutilization of radical cystectomy among patients diagnosed with MIBC, especially among older patients with significant comorbidities and non-Hispanic black patients. Patient summary Despite guideline recommendations, there is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer, especially for non-Hispanic black patients and older patients with significant comorbidities. There is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer in the USA, especially among non-Hispanic black patients and older patients with significant comorbidities. Further research is needed to qualitatively describe the factors that drive the decision to undergo surgery and improve rates of radical cystectomy in patients with bladder cancer.",
    keywords = "Bladder cancer, Disparities, Radical cystectomy, Utilization",
    author = "Stephen Williams and Jinhai Huo and Karim Chamie and Hu, {Jim C.} and Giordano, {Sharon H.} and Hoffman, {Karen E.} and Dinney, {Colin P.N.} and Kamat, {Ashish M.} and Shih, {Ya Chen Tina}",
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    TY - JOUR

    T1 - Underutilization of Radical Cystectomy Among Patients Diagnosed with Clinical Stage T2 Muscle-invasive Bladder Cancer

    AU - Williams, Stephen

    AU - Huo, Jinhai

    AU - Chamie, Karim

    AU - Hu, Jim C.

    AU - Giordano, Sharon H.

    AU - Hoffman, Karen E.

    AU - Dinney, Colin P.N.

    AU - Kamat, Ashish M.

    AU - Shih, Ya Chen Tina

    PY - 2017/4/1

    Y1 - 2017/4/1

    N2 - Background Radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer (MIBC). Objective We sought to identify population-based factors predicting the use of radical cystectomy. Design, setting, and patients Analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data for 3922 patients aged ≥66 yr diagnosed with clinical stage T2 MIBC from January 1, 2002 to December 31, 2011. Outcome measurements and statistical analysis We used univariate and multivariable regression analyses to identify factors predicting the use of radical cystectomy. Cox proportional hazards models were used to analyze survival outcomes. Results and limitations A total of 740 (18.9%) patients with MIBC underwent radical cystectomy. Older age at diagnosis (>80 vs 65–69 yr, odds ratio [OR] 0.15, 95% confidence interval [CI] 0.11–0.19; p < 0.001) and higher comorbidity (Charlson comorbidity index 3+ vs 0, OR 0.41, 95% CI 0.29–0.57; p < 0.001) were associated with lower use of radical cystectomy. Moreover, non-Hispanic black patients were less likely than white patients to undergo radical cystectomy (OR 0.62, 95% CI 0.40–0.96; p = 0.032) and pelvic lymph node dissection (OR 0.65, 95% CI 0.42–1.02; p = 0.058). Overall survival was better for patients who underwent radical cystectomy alone (hazard ratio [HR] 0.70, 95% CI 0.56–0.88; p = 0.002) and with lymph node dissection (HR 0.45, 95% CI 0.40–0.51; p < 0.001). Limitations include the limited ability of retrospective analysis to demonstrate causality. Conclusions There is significant underutilization of radical cystectomy among patients diagnosed with MIBC, especially among older patients with significant comorbidities and non-Hispanic black patients. Patient summary Despite guideline recommendations, there is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer, especially for non-Hispanic black patients and older patients with significant comorbidities. There is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer in the USA, especially among non-Hispanic black patients and older patients with significant comorbidities. Further research is needed to qualitatively describe the factors that drive the decision to undergo surgery and improve rates of radical cystectomy in patients with bladder cancer.

    AB - Background Radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer (MIBC). Objective We sought to identify population-based factors predicting the use of radical cystectomy. Design, setting, and patients Analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data for 3922 patients aged ≥66 yr diagnosed with clinical stage T2 MIBC from January 1, 2002 to December 31, 2011. Outcome measurements and statistical analysis We used univariate and multivariable regression analyses to identify factors predicting the use of radical cystectomy. Cox proportional hazards models were used to analyze survival outcomes. Results and limitations A total of 740 (18.9%) patients with MIBC underwent radical cystectomy. Older age at diagnosis (>80 vs 65–69 yr, odds ratio [OR] 0.15, 95% confidence interval [CI] 0.11–0.19; p < 0.001) and higher comorbidity (Charlson comorbidity index 3+ vs 0, OR 0.41, 95% CI 0.29–0.57; p < 0.001) were associated with lower use of radical cystectomy. Moreover, non-Hispanic black patients were less likely than white patients to undergo radical cystectomy (OR 0.62, 95% CI 0.40–0.96; p = 0.032) and pelvic lymph node dissection (OR 0.65, 95% CI 0.42–1.02; p = 0.058). Overall survival was better for patients who underwent radical cystectomy alone (hazard ratio [HR] 0.70, 95% CI 0.56–0.88; p = 0.002) and with lymph node dissection (HR 0.45, 95% CI 0.40–0.51; p < 0.001). Limitations include the limited ability of retrospective analysis to demonstrate causality. Conclusions There is significant underutilization of radical cystectomy among patients diagnosed with MIBC, especially among older patients with significant comorbidities and non-Hispanic black patients. Patient summary Despite guideline recommendations, there is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer, especially for non-Hispanic black patients and older patients with significant comorbidities. There is significant underutilization of radical cystectomy among patients diagnosed with bladder cancer in the USA, especially among non-Hispanic black patients and older patients with significant comorbidities. Further research is needed to qualitatively describe the factors that drive the decision to undergo surgery and improve rates of radical cystectomy in patients with bladder cancer.

    KW - Bladder cancer

    KW - Disparities

    KW - Radical cystectomy

    KW - Utilization

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