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Ladi-Seyedian SS, Ghoreifi A, Konety B, Pohar K, Holzbeierlein JM, Taylor J, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry. Cancers (Basel) 2024; 16:1268. [PMID: 38610946 PMCID: PMC11011163 DOI: 10.3390/cancers16071268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | - Alireza Ghoreifi
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | | | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH 43210, USA;
| | | | - John Taylor
- Department of Urology, University of Kansas, Kansas City, KS 66045, USA; (J.M.H.); (J.T.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA;
| | | | - Jennifer M. Taylor
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joseph C. Liao
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA;
| | | | - Sima P. Porten
- Department of Urology, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Gary D. Steinberg
- Department of Urology, Allina Health Cancer Institute, University of Minnesota, Minneapolis, MN 55407, USA;
| | - Mark D. Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Siamak Daneshmand
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
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Sereda Y, Alarid-Escudero F, Bickell NA, Chang SH, Colditz GA, Hur C, Jalal H, Myers ER, Layne TM, Wang SY, Yeh JM, Trikalinos TA. Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program. J Natl Cancer Inst Monogr 2023; 2023:219-230. [PMID: 37947329 PMCID: PMC11009510 DOI: 10.1093/jncimonographs/lgad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. METHODS Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. DISCUSSION The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.
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Affiliation(s)
- Yuliia Sereda
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hawre Jalal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Tracy M Layne
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute and Center for Scientific Diversity, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Departments of Health Services, Policy, & Practice and of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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Akinsola O, Klausner AP, Vince R, Scarpato KR. The Other Pandemic, Racism, in Urology. Urol Clin North Am 2023; 50:525-530. [PMID: 37775211 DOI: 10.1016/j.ucl.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Racism is deeply ingrained in our society with lasting effects within medicine. The COVID-19 pandemic further highlighted racial disparities in the medical field, including in the field of Urology. This has led to investigation regarding the effects of racism on education, patient care, and research within Urology. This article aims to review current literature on the "other pandemic," structural racism, within medicine and specifically urology and provide ways to combat its impact.
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Affiliation(s)
- Olutiwa Akinsola
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Adam P Klausner
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 7th Floor East Wing, Richmond, VA 23298, USA
| | - Randy Vince
- Case Western Reserve University, University Hospital Urology Institute, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Kristen R Scarpato
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
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Noel OD, Stewart E, Cress R, Dall'Era MA, Shrestha A. Underutilization of intravesical chemotherapy and immunotherapy for high grade non-muscle invasive bladder cancer in California between 2006-2018: Effect of race, age and socioeconomic status on treatment disparities. Urol Oncol 2023; 41:431.e7-431.e14. [PMID: 37295979 DOI: 10.1016/j.urolonc.2023.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/26/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Among patients diagnosed with non-muscle invasive bladder cancer (NMIBC), those with high risk disease have the greatest risk of recurrence and disease progression. The underutilization of intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) has been a longstanding concern in clinical practice. This study aimed to determine the disparities present in receipt of adjuvant intravesical chemotherapy and immunotherapy in treatment of patients with high grade NMIBC following initial transurethral resection of a bladder tumor (TURBT). METHODS The California Cancer Registry data was used to identify 19,237 patients diagnosed with high grade NMIBC who underwent TURBT. Treatment variables include re-TURBT, re-TURBT and intravesical chemotherapy (IVC) and/or BCG. Independent variables include age, sex, race/ethnicity, neighborhood socioeconomic status (nSES), primary insurance payer and marital status at diagnosis. Multiple logistic regression and multinomial regression models were used to examine variation in the treatments received following TURBT. RESULTS The proportion of patients receiving TURBT followed by BCG was similar across all racial and ethnic groups (28%-32%). BCG therapy was higher in patients belonging to the highest nSES quintile (37% for highest vs. 23%-26% for the 2 lowest quintiles). In multiple variable analyses, receipt of any intravesical therapy (IVT) was influenced by nSES, age, marital status, race/ethnicity, and insurance type. Patients in the lowest nSES quintile had a 45% less likelihood of receiving IVT compared to the highest nSES group (OR [95%CI]: 0.55[0.49, 0.61]). Race/ethnicity differences in receipt of any adjuvant therapy were noted in the middle to lowest nSES quintile for Hispanic and Asian/Pacific Islander patients when compared to non-Hispanic White patients. When comparing variation in treatment by insurance type at diagnosis, those with Medicare or other insurance were 24% and 30% less likely to receive BCG after TURBT compared to those with private insurance, (OR [95%CI]: 0.76 [0.70, 0.82] and 0.70[0.62, 0.79]) respectively. CONCLUSION In patients with a diagnosis of high risk NMIBC, disparities in utilization of BCG are seen based on SES, age, and insurance type.
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Affiliation(s)
- Onika Dv Noel
- Department of Urology, University of California Davis, Sacramento, CA
| | - Eric Stewart
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA
| | - Rosemary Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA; Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Marc A Dall'Era
- Department of Urology, University of California Davis, Sacramento, CA
| | - Anshu Shrestha
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA.
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5
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Paster IC, Chipollini J. AUTHOR REPLY. Urology 2023; 178:113. [PMID: 37438240 DOI: 10.1016/j.urology.2023.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Paster IC, Zeng J, Recio-Boiles A, Chipollini J. Gender, Racial and Ethnic Differences in Pathologic Response Following Neoadjuvant Chemotherapy for Bladder Cancer Patients. Urology 2023; 178:105-113. [PMID: 37230271 DOI: 10.1016/j.urology.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate trends and racial variations of pathologic complete response (CR) in patients with muscle-invasive bladder cancer undergoing cystectomy. MATERIALS AND METHODS The National Cancer Database was queried for patients with non-metastatic muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy and surgery. The primary endpoints, CR and mortality, were evaluated using the Cochran-Armitage test, multivariable regression, and Kaplan-Meier analyses. RESULTS The cohort comprised 9955 patients. Non-Hispanic Black (NHB) patients were younger (P < .001), had a higher clinical tumor (P < .001), and had higher clinical node (P = .029) stages at presentation. CR for non-Hispanic White (NHW), NHB, and Hispanic patients were 12.6%, 10.1%, and 11.8%, respectively (P = .030). There was a significant increase in CR trends for NHW patients (P < .001) and increases in NHB (P = .311) and Hispanic patients (P = .236). On multivariable analysis, NHW females had lower odds of achieving CR (odds ratio: 0.83, 95% CI: 0.71-0.97); however, NHB males (hazard ratio: 1.21, 1.01-1.44) and NHB females (hazard ratio: 1.25, 1.03-1.53) had higher overall mortality in adjusted analysis. Survival differences were not observed in patients who achieved CR, regardless of racial background; however, for those with residual disease, the 2-year survival probabilities were 60.7%, 62.5%, and 51.1% for NHW, HW, and NHB patients, respectively (log-rank P = .010). CONCLUSION Our findings revealed differences in chemotherapy response based on gender and race or ethnicity. The CR trends for all racial or ethnic groups increased over time. However, Black patients were found to have worse survival, particularly when residual disease was present. Clinical studies with more underrepresented minorities are needed to verify biological differences in response to neoadjuvant chemotherapy.
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Affiliation(s)
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
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W AC, GJ N, T M, A A, A T, AL W, A R, S UL, J U, D M, R I, MJA P, K P. The impact of socio-economic deprivation on recovery following robotic assisted radical cystectomy. Urologia 2022; 90:136-140. [PMID: 35673803 DOI: 10.1177/03915603221100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite enhanced recovery programmes, length of stay is variable following robotic assisted radical cystectomy (RARC). The aim of this study was to assess the impact socioeconomic deprivation on recovery following RARC. Methods: The prospectively maintained RARC databases at two tertiary referral hospitals were reviewed from 2015 to 2017. Demographic, histological, and outcome data including length of stay (LOS), operation time and blood loss were recorded. The Index of Multiple Deprivation, was chosen as a deprivation index as this is used by the UK government to direct funding and resources to regions, towns and postal codes by assessing a number of indicators. Results: During the study period, 340 consecutive patients underwent RARC. Deprivation deciles were significantly higher in site 1 patients (7.9 in site 1 vs 6.6 in site 2, p < 0.001) implying that these patients are more likely to have higher incomes, levels of education and improved living environments. The mean operating time was longer in the site 1 cohort (397 vs 366 min, p > 0.001) with a reduced mean blood loss volume (252 and 484 mL, p < 0.001). There was a significant difference in mean LOS (6.2 days in site 1 vs 10.6 days in site 2, p < 0.001). On multivariable analysis, a higher deprivation decile did not predict LOS (OR = 1, 95% CI = 0.9–1.1, p = 0.407). Sex and operation site were however significantly associated with LOS (p = 0.006 and <0.001). Conclusion: Recovery following RARC was independent of socioeconomic status when comparing two hospitals with diverse catchment areas in the UK.
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Affiliation(s)
- Abou Chedid W
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Nason GJ
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Mahesan T
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Ashton A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Tay A
- Department of Urology, St George’s Hospital, London, UK
| | - Walsh AL
- Department of Urology, St George’s Hospital, London, UK
| | - Roodhouse A
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe-Lewis S
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Uribe J
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Moschonas D
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Issa R
- Department of Urology, St George’s Hospital, London, UK
| | - Perry MJA
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Patil K
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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Effects of treatments on gender differences in patients with localized muscle-invasive bladder cancer. Int Urol Nephrol 2022; 54:1845-1855. [PMID: 35608804 DOI: 10.1007/s11255-022-03200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/27/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the gender differences in survival under different treatments in localized muscle-invasive bladder cancer (MIBC), and to find clinical strategies to improve the poor prognosis of female with bladder cancer (BC). METHODS Patients with localized MIBC were collected in the SEER database from 2010 to 2016 to analyze the gender differences in clinical characteristics. Propensity score matching was used to balance the effects of confounding factors. Kaplan-Meier method and Cox proportional hazards regression model were performed to compare the overall survival (OS) and cancer-specific survival (CSS) of patients between different treatment subgroups. RESULTS The entire cohort included 13,272 T2N0M0 MIBC patients, with a male-to-female incidence of 3:1. Compared with male patients, females had a higher age of onset and more blacks. There were more female patients undergoing bladder-sparing surgery (BSS) alone, and the OS and CSS were worse than those in males. The gender difference showed statistical significance in the BSS group, but not in the radical cystectomy (RC) group. CONCLUSION The survival of localized MIBC patients can be affected by treatments. Multi-modality treatment and RC may improve the survival prognosis of female patients.
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Washington SL, Gregorich SE, Meng MV, Suskind AM, Porten SP. Race modifies survival benefit of guideline-based treatment: Implications for reducing disparities in muscle invasive bladder cancer. Cancer Med 2020; 9:8310-8317. [PMID: 32869516 PMCID: PMC7666728 DOI: 10.1002/cam4.3429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Black individuals with muscle-invasive bladder cancer (MIBC) experienced 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed Black-White differences in survival. Yet little is known of how interactions between race/ethnicity and receipt of GBT drive within- and between-race survival differences. METHODS Black, White, and Latino individuals diagnosed with nonmetastatic, locally advanced MIBC from 2004 to 2013 within the National Cancer Database were included. Guideline-based treatment was defined as the receipt including one or more of the following treatment modalities: radical cystectomy (RC), neoadjuvant chemotherapy with RC, RC with adjuvant chemotherapy, and/or chemoradiation based on American Urological Association guidelines. Cox proportional hazards model of mortality estimated effects of GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. RESULTS Of the 54 910 MIBC individuals with 125 821 person-years of posttreatment observation (max = 11 years), 6.9% were Black, and 3.0% were Latino. Overall, 51.4%, 45.3%, and 48.5% of White, Black, and Latino individuals received GBT. Latino individuals had lower hazard of death compared to Black (HR 0.81, 95% CI 0.75-0.87) and White individuals (HR 0.92, 95% 0.86-0.98). With GBT, Latino and White individuals had similar outcomes (HR = 1.00, 95% 0.91-1.10) and both fared better than Black individuals (HR = 0.88, 95% 0.79-0.99 and HR = 0.88, 95% 0.83-0.94, respectively). Without GBT, Latino individuals fared better than White (HR = 0.85, 95% 0.77-0.93) and Black individuals (HR = 0.74, 95% 0.67-0.82) while White individuals fared better than Black individuals (HR = 0.87, 95% 0.83-0.92). Black individuals with GBT fared worse than Latinos without GBT (HR = 1.02, 95% 0.92-1.14), although not statistically significant. CONCLUSION Low GBT levels demonstrated an "under-allocation" of GBT to those who needed it most-Black individuals. Interventions to improve GBT allocation may mitigate race-based survival differences observed in MIBC.
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Affiliation(s)
| | | | - Maxwell V. Meng
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Anne M. Suskind
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Sima P. Porten
- Department of UrologyUniversity of CaliforniaSan FranciscoCAUSA
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