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Oswald D, Herrmann TRW, Netsch C, Becker B, Hatiboglu G, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Herrmann J, Gross AJ, Pallauf M, Deininger S, Ramesmayer C, Peters J, Lusuardi L. [Urinary diversion in old patients (80+ years)]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:795-803. [PMID: 39012493 PMCID: PMC11282126 DOI: 10.1007/s00120-024-02384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/17/2024]
Abstract
With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - T R W Herrmann
- Urologie, Abteilung für Urologie, Kantonsspital Frauenfeld, Frauenfeld, Schweiz
| | - C Netsch
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - B Becker
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Asklepios Klinik, Barmbek, Hamburg, Deutschland
| | | | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologie, Kantonsspital Münsterlingen, Münsterlingen, Schweiz
- Abteilung für Urologie, Uniklinikum Ulm, Abteilung für Urologie und Kinderurologie, Ulm, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - J Herrmann
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
- Klinik für Urologie und Urochirurgie, Universitätsklinkum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - A J Gross
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Pallauf
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - C Ramesmayer
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - J Peters
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Salzburger Landeskliniken, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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Tang Y, Lin L, Xiao Y, Meng L, Yang Y, Li X. Predictors of trimodality therapy in patients with muscle-invasive bladder cancer and effect on survival. Clin Transl Oncol 2024; 26:446-455. [PMID: 37389736 DOI: 10.1007/s12094-023-03264-9] [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] [Received: 05/05/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Due to its unique advantages over radical cystectomy (RC), trimodality therapy (TMT) is increasingly being utilized by patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not suitable for or refuse RC. However, achieving a satisfactory oncological outcome with TMT requires strict patient selection criteria, and the comparative oncological outcomes of TMT versus RC remain controversial. METHODS Patients diagnosed with non-metastatic MIBC who underwent TMT or RC were identified from the SEER database during 2004-2015. Before one-to-one propensity score matching (PSM), logistic regression was utilized to identify predictors of TMT. After matching, K-M curves were generated to estimate cancer-specific survival (CSS) and overall survival (OS) with log-rank to test the significance. Finally, we conducted univariate and multivariate Cox analyses to identify independent prognostic factors for CSS and OS. RESULTS The RC and TMT groups included 5812 and 1260 patients, respectively, and the TMT patients were significantly older than the RC patients. Patients with advanced age, separated, divorced, or widowed (SDW) or unmarried marital status (married as reference), and larger tumor size (< 40 mm as reference) were more likely to be treated with TMT. After PSM, TMT was found to be associated with worse CSS and OS, and it was identified as an independent risk factor for both CSS and OS. CONCLUSION MIBC patients may not be carefully evaluated prior to TMT, and some non-ideal candidates underwent TMT. TMT resulted in worse CSS and OS in the contemporary era, but these results may be biased. Strict TMT candidate criteria and TMT treatment modality should be required.
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Affiliation(s)
- Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Lede Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Linghao Meng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Yujia Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China.
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Moon S, Pandya V, McDonald A, Basu A, Bae S, Ferguson JE. Analysis of treatment of muscle invasive bladder cancer using the national cancer database: Factors associated with receipt of aggressive therapy. Urol Oncol 2023; 41:456.e13-456.e20. [PMID: 37640572 DOI: 10.1016/j.urolonc.2023.08.003] [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] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To characterize the treatments received by muscle-invasive bladder cancer (MIBC) patients, analyze their use according to sociodemographic, clinical, pathologic, and facility variables, and identify possibilities for improvement in care, with the understanding that patients with MIBC face a potentially lethal disease, yet often do not receive guideline-concordant potentially curative therapies. MATERIALS AND METHODS Using the National Cancer Data Base (NCDB), we analyzed 102,119 patients with MIBC diagnosed from 2009 to 2018. Treatments included cystectomy, radiation, chemotherapy (CT), or observation. Treatments including cystectomy or radiotherapy (RT) ≥50 Gy were considered aggressive therapy (AT). A multivariable generalized estimating equation model was used to assess the impact of the independent variables with receiving AT, using SAS version 9.4. RESULTS The median age was 73 years, with 72.9% male, 84.3% White, and 7.1% Black. Stage distribution was 59.4% stage II, 23.0% stage III, and 17.6% stage IV. Overall, 55.2% of patients received AT, while 41.1% did not, with 26.6% receiving observation alone after transurethral resection of bladder tumor. 45.4% received cystectomy, 9.8% received RT, and 12.8% received CT as primary treatment. Notably, over 30% of patients ages 50 to 70 did not receive aggressive therapy. On multivariate analysis, factors associated with nonreceipt of AT included age >70 (OR < 0.79, P < 0.0001), Black race (OR 0.70, P < 0.0001), underinsured status (OR 0.62, P < 0.0001), high comorbidity (OR 0.74, P < 0.0001), and treatment at low volume (OR 0.72 P < 0.0001) or nonacademic cancer program (OR 0.54, P < 0.0001). Long-term trends included increases in utilization of perioperative CT (17.5% in 2009 to 46.7% in 2018, P < 0.001), and chemoradiation (5.4% in 2009 to 8.8% in 2018, P < 0.001). Using Cox regression analysis to control for confounding variables, receipt of aggressive therapy was associated with improved overall survival. CONCLUSIONS Over a third of patients did not receive AT for MIBC, with many of these patients seemingly eligible by age and comorbidity status. Prospective studies are needed to determine why these patients do not receive AT. A better understanding of patient vs. access to care vs. provider factors will help to focus efforts to improve care for MIBC patients.
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Affiliation(s)
- Sol Moon
- Department of Urology, University of Alabama Birmingham, Birmingham, AL
| | - Vishruti Pandya
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Andrew McDonald
- Department of Radiation Oncology, University of Alabama Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama Birmingham, Birmingham, AL
| | - Arnab Basu
- Department of Medicine, Division of Hematology-Oncology, University of Alabama Birmingham, Birmingham, AL
| | - Sejong Bae
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - James E Ferguson
- Department of Urology, University of Alabama Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; O'Neal Comprehensive Cancer Center, Birmingham, AL.
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Saravanabavan S, Prakash GJ, Joshi A, Pal M, Gujela A, Arora A, Bakshi G, Prabhash K, Noronha V, Murthy V, Maitre P, Teja R. Patterns of Utilization and Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced-urothelial Bladder Cancer (LABC)-Real World Data From an Indian Tertiary Care Cancer Center. Clin Genitourin Cancer 2023; 21:e326-e333. [PMID: 37211451 DOI: 10.1016/j.clgc.2023.03.013] [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] [Received: 12/14/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 05/23/2023]
Abstract
AIM Optimal utilization of perioperative systemic therapy in locally advanced bladder cancer (LABC) holds the key in improving the survival outcomes. We aim to analyze the oncological outcomes of clinically locally advanced urothelial bladder cancer patients treated with neoadjuvant (NACT) or adjuvant chemotherapy or without any systemic therapy in the perioperative period of radical cystectomy. METHODS & MATERIAL We retrospectively analyzed the medical records of patients with cancer of the urinary bladder diagnosed between 2012 and 2020. The demographic profile, and the treatment received, was recorded for all patients. Oncological outcomes of the patients based on these variables were analyzed. RESULTS Two hundred and twenty nine (229) locally advanced bladder cancer patients were included in the study. Eighty eight (38%) of them underwent upfront radical cystectomy and 141 (62%) received neoadjuvant chemotherapy (NACT). With a median follow-up of 27 months, the 2-year DFS in either of the groups was 65.4% and 67.1% respectively (P - 0.373). In the multivariate analysis, the pathological lymph nodal status and lymph vascular invasion (LVI) status influenced the DFS. The initial modality of management chosen did not affect the outcome. (HR - 0.688; 95% CI: 0.38-1.21). The commonest reason for not receiving NACT was Cisplatin ineligibility due to malignant obstructive uropathy and a subgroup analysis of this set of patients also did not show any significant difference in 2 year DFS compared to those who received NACT. CONCLUSION A significant proportion of patients with LABC are unable to receive the recommended neoadjuvant chemotherapy and obstructive uropathy is the commonest reason for this in our centre. In our single centre series upfront radical cystectomy followed by adjuvant platinum based therapy had an outcome similar to neoadjuvant chemotherapy in LABC patients, in patients who were unable to receive the same due to various reasons.
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Affiliation(s)
- Srivishnu Saravanabavan
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Gagan J Prakash
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001.
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001. https://twitter.com/https://twitter.com/drgaganprakash
| | - Mahendra Pal
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ajit Gujela
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Amandeep Arora
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ganesh Bakshi
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ravi Teja
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
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Bokarica P, Alfirević M, Hrkać A, Glas AM, Tomašković I. Letter to the Editor regarding the Article "Postoperative Mortality Rate after Radical Cystectomy: A Systematic Review of Epidemiologic Series". Urol Int 2023; 107:839-840. [PMID: 37231948 DOI: 10.1159/000530576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Pero Bokarica
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Maša Alfirević
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Adelina Hrkać
- Department of Urology, University Hospital "Sveti Duh", Zagreb, Croatia
| | | | - Igor Tomašković
- Department of Urology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
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Williams SB, Shan Y, Fero KE, Movva G, Baillargeon J, Tyler DS, Chamie K. Comparing costs of renal preservation versus radical nephroureterectomy management among patients with non-metastatic upper tract urothelial carcinoma. Urol Oncol 2022; 40:345.e1-345.e7. [DOI: 10.1016/j.urolonc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
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Wessels F, Bußoff I, Adam S, Kowalewski KF, Neuberger M, Nuhn P, Michel MS, Kriegmair MC. Comorbidity Scores and Machine Learning Methods Can Improve Risk Assessment in Radical Cystectomy for Bladder Cancer. Bladder Cancer 2022; 8:155-163. [PMID: 38993365 PMCID: PMC11181714 DOI: 10.3233/blc-211640] [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: 11/24/2021] [Accepted: 04/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-operative risk assessment in radical cystectomy (RC) is an ongoing challenge especially in elderly patients. OBJECTIVE To evaluate the ability of comorbidity indices and their combination with clinical parameters in machine learning models to predict mortality and morbidity after RC. METHODS In 392 patients who underwent open RC, complication and mortality rates were reported. The predictive values of the age-adjusted Charlson Comorbidity index (aCCI), the Elixhauser Index (EI), the Physical Status Classification System (ASA) and Gagne's combined comorbidity Index (GCI) were evaluated using regression analyses. Various machine learning models (Gaussian naïve bayes, logistic regression, neural net, decision tree, random forest) were additionally investigated. RESULTS The aCCI, ASA and GCI showed significant results for the prediction of complications (χ2 = 8.8, p < 0.01, χ2 = 15.7, p < 0.01 and χ2 = 4.6, p = 0.03) and mortality (χ2 = 21.1, p < 0.01, χ2 = 25.8, p < 0.01 and χ2 = 2.4, p = 0.04) after RC while the EI showed no significant prediction. However, areas under receiver characteristic curves (AUROCs) revealed good performance only for the prediction of mortality by the aCCI and ASA (0.81 and 0.78, CGI 0.63) while the prediction of complications was poor (aCCI 0.6, ASA 0.63, CGI 0.58). The combination of ASA, age, body mass index and sex in machine learning models showed a better prediction. Gaussian naïve bayes (0.79) and logistic regression (0.76) showed the best performance using a hold-out test set. CONCLUSIONS The ASA and aCCI show good prediction of mortality after RC but fail predicting complications accurately. Here, the combination of comorbidity indices and clinical parameters in machine learning models seems promising.
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Affiliation(s)
- Frederik Wessels
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Isabelle Bußoff
- Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Sophia Adam
- Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Medical Faculty of Heidelberg University, Mannheim, Germany
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Long term cost comparisons of radical cystectomy versus trimodal therapy for muscle-invasive bladder cancer. Urol Oncol 2022; 40:273.e1-273.e9. [DOI: 10.1016/j.urolonc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
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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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Treatment trends for muscle-invasive bladder cancer in Germany from 2006 to 2019. World J Urol 2022; 40:1715-1721. [PMID: 35486177 PMCID: PMC9237006 DOI: 10.1007/s00345-022-04017-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose To examine national treatment trends of muscle-invasive bladder cancer (MIBC) in Germany with a special focus on radical cystectomy (RC). Patients and methods Population-based data were derived from the nationwide hospital billing database of the German Federal Statistical Office and institution-related information from the reimbursement.INFO tool based on hospitals’ quality reports from 2006 to 2019. Additionally, we used the German National Center for Cancer Registry data to analyze all cases of bladder cancer with stage ≥ T2 who received RC, chemotherapy, radiation therapy or a combination from 2006 to 2017. Results The annual number of RC cases in Germany increased by 28% from 5627 cases in 2006 to 7292 cases in 2019 (p = 0.001). The proportion of patients undergoing RC remained constant at about 75% in all age groups between 2006 and 2017 (p = 0.3). Relative to all performed RC, the proportion of patients > 75 years increased from 25% in 2006 to 38% in 2019 (p = 0.03). The proportion of patients receiving a combination of RC and chemotherapy increased from 9% in 2006 to 13% in 2017 (p = 0.005). In 2006, 8 of 299 urology departments (2.7%) performed more than 50 RCs per year, which increased to 17 of 360 (4.7%) in 2019. In 2019, 107 departments (29%) performed 25–49 RCs and 236 (66%) departments performed < 25 RCs. Conclusion In Germany, three out of four patients with MIBC receive RC and the proportion of patients > 75 years is increasing. The combination of surgery and chemotherapy is increasingly used. With overall increasing case numbers, there is a slight tendency towards centralization. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04017-z.
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Bree KK, Shan Y, Hensley PJ, Lobo N, Hu C, Tyler DS, Chamie K, Kamat AM, Williams SB. Management, Surveillance Patterns, and Costs Associated With Low-Grade Papillary Stage Ta Non-Muscle-Invasive Bladder Cancer Among Older Adults, 2004-2013. JAMA Netw Open 2022; 5:e223050. [PMID: 35302627 PMCID: PMC8933744 DOI: 10.1001/jamanetworkopen.2022.3050] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Low-risk non-muscle-invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality; however, patients with low-risk NMIBC may often receive non-guideline-recommended and potentially costly surveillance testing and treatment. OBJECTIVE To describe current surveillance and treatment practices, cancer outcomes, and costs of care for low-grade papillary stage Ta (low-grade Ta) NMIBC and identify factors associated with increased cost of care. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study identified 13 054 older adults (aged 66-90 years) diagnosed with low-grade Ta tumors in the Surveillance, Epidemiology and End Results-linked Medicare database from January 1, 2004, through December 31, 2013. Medicare claims data through December 31, 2014, were also reviewed. Data were analyzed from April 1 to October 6, 2021. EXPOSURES Surveillance testing and treatment among patients with low-grade Ta NMIBC. MAIN OUTCOMES AND MEASURES The primary outcome was patterns in population-level surveillance and treatment practice over time among patients with low-grade Ta NMIBC. Secondary outcomes were recurrence (defined as receipt of subsequent transurethral resection of bladder tumor >3 months after index diagnosis of NMIBC and initial transurethral resection of bladder tumor), progression (defined as receipt of definitive treatment for bladder cancer), and costs of care. RESULTS Among 13 054 patients who met inclusion criteria, 9596 (73.5%) were male and 3458 (26.5%) were female, with a median age of 76 years (IQR, 71-81 years). A total of 403 patients (3.1%) were Black, 120 (0.9%) were Hispanic, 12 123 (92.9%) were White, and 408 (3.1%) were of other races and/or ethnicities. Rates of surveillance cystoscopy increased over the study period (from 79.3% in 2004 to 81.5% in 2013; P = .007), with patients receiving a median of 3.0 cystoscopies per year (IQR, 2.0-4.0 per year). Rates of upper tract imaging (particularly computed tomography or magnetic resonance imaging) also increased over the study period (from 30.4% in 2004 to 47.0% in 2013; P < .001), with most patients receiving a median of 2.0 imaging tests per year (IQR, 1.0-2.0 per year). The use of urine cytologic testing or other urine biomarker assessment also increased (from 44.8% in 2004 to 54.9% in 2013; P < .001). Rates of adherence to current guidelines were similar over time (eg, a median of 4398 patients [55.2%] received ≤2 cystoscopies per year in 2004-2008 vs a median of 2736 patients [53.8%] in 2009-2013; P = .11), suggesting overuse of all surveillance testing modalities. With regard to treatment, 2250 patients (17.2%) received intravesical bacillus Calmette-Guérin, and 792 patients (6.1%) received intravesical chemotherapy (excluding receipt of a single perioperative dose). Among all patients with low-grade Ta NMIBC, 217 (1.7%) experienced disease recurrence and 52 (0.4%) experienced disease progression. The total annual median costs of low-grade Ta surveillance testing and treatment increased by 60% (from $34 792 in 2004 to $53 986 in 2013), with higher 1-year median expenditures noted among those with disease recurrence ($76 669) vs no disease recurrence ($53 909) at the end of the study period. CONCLUSIONS AND RELEVANCE In this cohort study, despite low rates of disease recurrence and progression, rates of surveillance testing increased during the study period. The annual cost of care also increased over time, particularly among patients with recurrent disease. Efforts to improve adherence to current practice guidelines, with the focus on limiting overuse of surveillance testing and treatment, may mitigate associated increasing costs of care.
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Affiliation(s)
- Kelly K. Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston
| | - Yong Shan
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston
| | - Patrick J. Hensley
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston
| | - Niyati Lobo
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston
| | - Chengrui Hu
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston
| | - Douglas S. Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston
| | - Karim Chamie
- Department of Urology, University of California, Los Angeles, Los Angeles
| | - Ashish M. Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston
| | - Stephen B. Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston
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12
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Schmidt B, Velaer KN, Thomas IC, Ganesan C, Song S, Pao AC, Thong AE, Liao JC, Chertow GM, Skinner EC, Leppert JT. Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer. EUR UROL SUPPL 2022; 35:29-36. [PMID: 35024629 PMCID: PMC8738897 DOI: 10.1016/j.euros.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are poor candidates for standard treatments for muscle-invasive bladder cancer (MIBC) and may be more likely to experience adverse outcomes when diagnosed with MIBC. Objective To investigate factors associated with the development of advanced CKD following radical cystectomy. Design setting and participants Using national Veterans Health Administration utilization files, we identified 3360 patients who underwent radical cystectomy for MIBC between 2004 and 2018. Outcome measurements and statistical analysis We examined factors associated with the development of advanced CKD (estimated glomerular filtration rate [eGFR] of <30 ml/min/1.73 m2) after radical cystectomy using multivariable logistic and proportional hazard regression, with and without consideration of competing risks. We examined survival using Kaplan-Meier product limit estimates and proportional hazard regression. Results and limitations The median age at surgery was 67 yr and the mean preoperative eGFR was 69.1 ± 20.3 ml/min/1.73 m2. Approximately three out of ten patients (n = 962, 29%) progressed to advanced CKD within 12 mo. Older age (hazard ratio [HR] per 5-yr increase 1.15, 95% confidence interval [CI] 1.10-1.20), preoperative hydronephrosis (HR 1.50, 95% CI 1.29-1.76), adjuvant chemotherapy (HR 1.19, 95% CI 1.00-1.41), higher comorbidity index (HR 1.13, 95% CI 1.11-1.16 per point), and lower baseline kidney function (HR 0.75, 95% CI 0.73-0.78) were associated with the development of advanced CKD. Baseline kidney function at the time of surgery was associated with survival. Generalizability is limited due to the predominantly male cohort. Conclusions Impaired kidney function at baseline is associated with progression to advanced CKD and mortality after radical cystectomy. Preoperative kidney function should be incorporated into risk stratification algorithms for patients undergoing radical cystectomy. Patient summary Impaired kidney function at baseline is associated with progression to advanced chronic kidney disease and mortality after radical cystectomy.
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Affiliation(s)
- Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Huntsman Cancer Institte, University of Utah, Salt Lake City, UT, USA
| | - Kyla N Velaer
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Calyani Ganesan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shen Song
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Pao
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Glenn M Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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13
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Korkes F, Fernandes E, Gushiken FA, Glina FPA, Baccaglini W, Timóteo F, Glina S. Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review. Int Braz J Urol 2022; 48:18-30. [PMID: 33861058 PMCID: PMC8691241 DOI: 10.1590/s1677-5538.ibju.2020.0892] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE A systematic review of the literature with available published literature to compare ileal conduit (IC) and cutaneous ureterostomy (CU) urinary diversions (UD) in terms of perioperative, functional, and oncological outcomes of high-risk elderly patients treated with radical cystectomy (RC). Protocol Registration: PROSPERO ID CRD42020168851. MATERIALS AND METHODS A systematic review, according to the PRISMA Statement, was performed. Search through the Medline, Embase, Scopus, Scielo, Lilacs, and Cochrane Database until July 2020. RESULTS The literature search yielded 2,883 citations and were selected eight studies, including 1096 patients. A total of 707 patients underwent IC and 389 CU. Surgical procedures and outcomes, complications, mortality, and quality of life were analyzed. CONCLUSIONS CU seems to be a safe alternative for the elderly and more frail patients. It is associated with faster surgery, less blood loss, lower transfusion rates, a lower necessity of intensive care, and shorter hospital stay. According to most studies, complications are less frequent after CU, even though mortality rates are similar. Studies with long-term follow up are awaited.
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Affiliation(s)
- Fernando Korkes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Eduardo Fernandes
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Arakaki Gushiken
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Felipe Placco Araujo Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Willy Baccaglini
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Frederico Timóteo
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
- Hospital Municipal da Vila Santa CatarinaSão PauloSPBrasilHospital Municipal da Vila Santa Catarina, São Paulo, SP, Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Sidney Glina
- Faculdade de Medicina do ABCDivisão de UrologiaSanto AndréSPBrasilDivisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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14
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Murthy PB, Lone Z, Corrigan D, Campbell R, Munoz-Lopez C, Caveney M, Gerber D, Ericson KJ, Thomas L, Zhang JH, Kaouk J, Weight C, Berglund R, Haber GP, Lee BH. Survival outcomes following radical cystectomy in patients with prior pelvic radiation for prostate cancer: A matched cohort analysis. Urol Oncol 2021; 40:10.e13-10.e19. [PMID: 34400070 DOI: 10.1016/j.urolonc.2021.06.017] [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: 01/27/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the impact of prior pelvic radiation therapy (XRT) on outcomes following radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS We performed a retrospective review comparing patients with bladder cancer requiring RC and prior history of XRT for prostate cancer to those undergoing RC without XRT history at our institution from 2011-2018. Propensity score matching was performed with the following variables: age, chronic kidney disease, nutritional deficiency, neoadjuvant chemotherapy use, Charlson comorbidity index, surgical approach, urinary diversion type, and pathologic T-stage. Perioperative, pathologic and oncologic outcomes were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Categorical variables were assessed utilizing the Pearson Chi Square Test, and continuous variables with the Wilcoxon rank-sum test. The Kaplan-Meier method with stratified-log rank was used to compare survival outcomes. Multivariable Cox proportional hazards models were utilized to identify predictors of overall and recurrence free survival. RESULTS 227 patients were included, of which 47 had radiotherapy for prostate cancer. 47% of patients in the radiation cohort received external beam radiation therapy, 47% received brachytherapy and 7% received both. There were no differences in recurrence-free survival (P = 0.82) or overall survival (P = 0.25). Statistically significant differences in perioperative or postoperative outcomes such as 90-day complication, readmission, mortality rates, or ureteroenteric anastomotic stricture rates were not found. Rates of node-positive disease, median lymph node yield, positive surgical margin rates, lymphovascular invasion, or variant histology were not significantly different between cohorts. CONCLUSIONS After matching for T-stage and other clinical variables, history of pelvic XRT for prostate cancer in patients who later required RC for bladder cancer, was not associated with an increased rate of perioperative complications or an independent predictor of RFS or OS.
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Affiliation(s)
- Prithvi B Murthy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Dillon Corrigan
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH
| | - Rebecca Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Maxx Caveney
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Gerber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Kyle J Ericson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Lewis Thomas
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Byron H Lee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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15
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Real World Outcomes of Patients with Bladder Cancer: Effectiveness Versus Efficacy of Modern Treatment Paradigms. Hematol Oncol Clin North Am 2021; 35:597-612. [PMID: 33958153 DOI: 10.1016/j.hoc.2021.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bladder cancer remains a common and insidious disease in the United States. There have been several advances in the understanding of the biology of bladder cancer, novel diagnostic tools, improvements in multidisciplinary care pathways, and new therapeutics for advanced disease over the past few decades. Clinical trials have demonstrated efficacy for new treatments in each disease state, but additional work is needed to advance the effectiveness of bladder cancer care. Real world data provide critical information regarding patterns of care, adverse events, and outcomes helping to bridge the efficacy versus effectiveness gap.
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16
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Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021; 11:e043266. [PMID: 33853799 PMCID: PMC8054090 DOI: 10.1136/bmjopen-2020-043266] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these. DESIGN Systematic review. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC. CONCLUSION Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC. PROSPERO REGISTRATION NUMBER 104937.
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Affiliation(s)
- Sophia Liff Maibom
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
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17
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Bitiņa-Barlote Ē, Plonis J, Cauce V, Vjaters E, Gardovskis J, Miklaševičs E, Nakazawa-Miklaševiča M. Bladder cancer trends in Latvia during 1990-2017: incidence, mortality, and survival rates. Cent European J Urol 2021; 74:14-23. [PMID: 33976911 PMCID: PMC8097650 DOI: 10.5173/ceju.2021.0266.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to evaluate bladder cancer (BC) incidence, mortality and survival trends in Latvia over the past 28 years. Material and methods Our study included patients diagnosed with BC between 1990 and 2017. The data were obtained from the national population-based cancer registry. Joinpoint regression analysis was used to identify points where a significant change in incidence and mortality trends occurred, accordingly with the patient’s gender and age. Relative survival (RS) was estimated by Ederer I and II methods. Results Altogether, 9589 patients with initial BC diagnosis were included in the study. The age-standardised (ASR) incidence rates (per 100,000) increased from 6.8 in 1990 to 12.5 in 2014 followed by a statistically insignificant decrease continuing up to 2017. The ASR BC mortality rates (per 100,000) also rose from 3.9 in 1990 to 4.4 in 2017. However, there was a decline in BC mortality trends in the age-group 40–59 with annual percentage change (APC) -1.1%. RS rates increased from 55.0 % in 1990–2000 to 59.0% in years 2013–2017. Conclusions This study revealed that the incidence and mortality rates have been gradually increasing over the past 28 years. The exception being cancer-specific mortality in the age group 40–59, which tends to decrease. Although the 5-year RS rates improved over the reviewed period, there is still plenty of room for improvement.
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Affiliation(s)
- Ērika Bitiņa-Barlote
- Rīga Stradiņš University, Institute of Oncology, Riga, Latvia.,Center of Urology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Juris Plonis
- Rīga Stradiņš University, Institute of Oncology, Riga, Latvia.,Center of Urology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Vinita Cauce
- Rīga Stradiņš University, Statistics Unit, Riga, Latvia
| | - Egils Vjaters
- Rīga Stradiņš University, Institute of Oncology, Riga, Latvia.,Center of Urology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
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18
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Jiang DM, Gupta S, Kitchlu A, Meraz-Munoz A, North SA, Alimohamed NS, Blais N, Sridhar SS. Defining cisplatin eligibility in patients with muscle-invasive bladder cancer. Nat Rev Urol 2021; 18:104-114. [PMID: 33432181 DOI: 10.1038/s41585-020-00404-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/29/2023]
Abstract
The current treatment paradigm for muscle-invasive bladder cancer (MIBC) consists of cisplatin-based neoadjuvant chemotherapy followed by local definitive therapy, or local definitive therapy alone for cisplatin-ineligible patients. Given that MIBC has a high propensity for distant relapse and is a chemotherapy-sensitive disease, under-utilization of chemotherapy is associated with suboptimal cure rates. Cisplatin eligibility criteria are defined for patients with metastatic bladder cancer by the Galsky criteria, which include creatinine clearance ≥60 ml/min. However, consensus is still lacking regarding cisplatin eligibility criteria in the neoadjuvant, curative MIBC setting, which continues to represent a substantial barrier to the standardization of patient care and clinical trial design. Jiang and colleagues accordingly suggest an algorithm for assessing cisplatin eligibility in patients with MIBC. Instead of relying on an absolute renal function threshold, their algorithm emphasizes a multidisciplinary and patient-centred approach. They also propose mitigation strategies to minimize the risk of cisplatin-induced nephrotoxicity in selected patients with impaired renal function. This new framework is aimed at reducing the inappropriate exclusion of some patients from cisplatin-based neoadjuvant chemotherapy (which leads to under-treatment) and harmonizing clinical trial design, which could lead to improved overall outcomes in patients with MIBC.
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Affiliation(s)
- Di Maria Jiang
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shilpa Gupta
- Department of Hematologic and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Abhijat Kitchlu
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Meraz-Munoz
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott A North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nimira S Alimohamed
- Department of Medicine, Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Normand Blais
- Division of Medical Oncology and Hematology, Department of Medicine, Centre Hospitalier de l'Université de Montréal; Université de Montréal, Montreal, Quebec, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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19
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Elshabrawy A, Wang H, Satsangi A, Wheeler K, Ramamurthy C, Pruthi D, Kaushik D, Liss M, Gelfond J, Fernandez R, Gore J, Svatek R, Mansour AM. Correlates of refusal of radical cystectomy in patients with muscle-invasive bladder cancer. Urol Oncol 2021; 39:236.e9-236.e20. [PMID: 33423936 DOI: 10.1016/j.urolonc.2020.11.023] [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: 05/28/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate factors associated with radical cystectomy (RC) refusal, subsequent treatment decisions, and their influence on overall survival (OS). MATERIALS AND METHODS We queried the National Cancer Database for patients with non-metastatic muscle-invasive bladder cancer (MIBC), cT2-T4M0. Patients who refused recommended RC were further stratified by treatment into chemotherapy, radiation therapy, chemoradiotherapy, and no treatment groups. Patients were excluded from the analysis if surgery was not planned, not recommended; or if survival data were unknown. Multivariate logistic regression modeling was utilized to identify independent predictors of refusing RC. Cox proportional hazards model with propensity score overlap weighting was utilized to identify survival predictors. Kaplan-Meier analysis was utilized to evaluate survival according to treatment. RESULTS A total of 74,159 MIBC patients were identified. Among patients with documented reasons for no surgery, 5.4% refused RC despite physician recommendation. Predictors of refusal on multivariate analysis included female gender (P = 0.016), advancing age ≥80 (vs. <60, P < 0.001), African American race (vs. white, P < 0.001) Medicaid (vs. private insurance, P < 0.001) and advancing T stage (T4 vs. T2, P < 0.001). Patients treated at academic centers were less likely to decline RC (vs. community centers, P < 0.001). Median survival after RC was 40.44 months vs. 12.52 months in refusal group. Undergoing chemoradiation had significantly improved survival in those patients compared to monotherapy or no treatment (hazard ratio 0.25, P < 0.001). Overlap weighted model Identified RC refusal as an independent predictor of poor OS (P < 0.001). CONCLUSIONS Several sociodemographic and clinical factors are associated with refusing radical cystectomy. Such refusal is associated with poor survival outcomes.
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Affiliation(s)
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Arpan Satsangi
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | - Karen Wheeler
- Department of Urology, UT Health San Antonio, San Antonio, TX
| | | | - Deepak Pruthi
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Dharam Kaushik
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Michael Liss
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - Roman Fernandez
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX
| | - John Gore
- Department of Urology, University of Washington, Seattle, WA
| | - Robert Svatek
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX
| | - Ahmed M Mansour
- Department of Urology, UT Health San Antonio, San Antonio, TX; UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX; Urology and Nephrology Center, Mansoura University, Egypt.
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20
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Sathianathen NJ, Fan Y, Jarosek SL, Konety I, Weight CJ, Vinogradov S, Konety BR. Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness. Eur Urol Focus 2020; 6:1180-1187. [DOI: 10.1016/j.euf.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/29/2019] [Accepted: 02/08/2019] [Indexed: 11/12/2022]
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21
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Bagheri I, Shan Y, Klaassen Z, Kamat AM, Konety B, Mehta HB, Baillargeon JG, Srinivas S, Tyler DS, Swanson TA, Kaul S, Hollenbeck BK, Williams SB. Comparing Costs of Radical Versus Partial Cystectomy for Patients Diagnosed With Localized Muscle-Invasive Bladder Cancer: Understanding the Value of Surgical Care. Urology 2020; 147:127-134. [PMID: 32980405 DOI: 10.1016/j.urology.2020.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 08/09/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare costs associated with radical versus partial cystectomy. Prior studies noted substantial costs associated with radical cystectomy, however, they lack surgical comparison to partial cystectomy. METHODS A total of 2305 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 to December 31, 2011 were included. Total Medicare costs within 1 year of diagnosis following radical versus partial cystectomy were compared using inverse probability of treatment-weighted propensity score models. Cox regression and competing risks analysis were used to determine overall and cancer-specific survival, respectively. RESULTS Median total costs were not significantly different for radical than partial cystectomy in 90 days ($73,907 vs $65,721; median difference $16,796, 95% CI $10,038-$23,558), 180 days ($113,288 vs $82,840; median difference $36,369, 95% CI $25,744-$47,392), and 365 days ($143,831 vs $107,359; median difference $34,628, 95% CI $17,819-$53,558), respectively. Hospitalization, surgery, pathology/laboratory, pharmacy, and skilled nursing facility costs contributed largely to costs associated with either treatment. Patients who underwent partial cystectomy had similar overall survival but had worse cancer-specific survival (Hazard Ratio 1.45, 95% Confidence Interval, 1.34-1.58, P < .001) than patients who underwent radical cystectomy. CONCLUSION While treatments for bladder cancer are associated with substantial costs, we showed radical cystectomy had comparable total costs when compared to partial cystectomy among patients with muscle-invasive bladder cancer. However, partial cystectomy resulted in worse cancer-specific survival further supporting radical cystectomy as a high-value surgical procedure for muscle-invasive bladder cancer.
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Affiliation(s)
- Iyla Bagheri
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Yong Shan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Jacques G Baillargeon
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Sunay Srinivas
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX.
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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23
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Ripping TM, Witjes JA, Meijer RP, van Rhijn BWG, Oddens JR, Goossens-Laan CA, Mulder SF, van Moorselaar RJA, Kiemeney LA, Aben KKH. Hospital-specific probability of cystectomy affects survival from muscle-invasive bladder cancer. Urol Oncol 2020; 38:935.e9-935.e16. [PMID: 32917503 DOI: 10.1016/j.urolonc.2020.08.014] [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: 02/21/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Radical cystectomies (RCs) are increasingly centralized, but bladder cancer can be diagnosed in every hospital The aim of this study is to assess the variation between hospitals of diagnosis in a patient's chance to undergo a RC before and after the volume criteria for RCs, to identify factors associated with this variation and to assess its effect on survival. METHODS AND MATERIALS Patients diagnosed with muscle-invasive bladder cancer (cT2-4a,N0/X,M0/X) without nodal or distant metastases between 2008 and 2016 were identified through the Netherlands Cancer Registry. Multilevel logistic regression analysis was used to investigate the hospital specific probability of undergoing a cystectomy. Cox proportional hazard regression analysis was used to assess the case-mix adjusted effect of hospital-specific probabilities on survival. RESULTS Of the 9,215 included patients, 4,513 (49%) underwent a RC. The percentage of RCs varied between 7% and 83% by hospital of diagnosis before the introduction of the first volume criteria (i.e., 2008-2009; minimum of 10 RCs). This variation decreased slightly to 17%-77% after establishment of the second volume criteria (i.e., 2015-2016; minimum of 20 RCs). Age, cT-stage and comorbidity were inversely and socioeconomic status was positively associated with RC. Both being diagnosed in a community hospital and/or being diagnosed in a hospital fulfilling the RC volume criteria were associated with increased use of RC compared to academic hospitals and hospitals not fulfilling the volume criteria. For each 10% increase in the percentage of RC in the hospital of diagnosis, 2-year case-mix adjusted survival increased 4% (hazard ratio 0.96, 95% confidence interval 0.94-0.98). CONCLUSION Probability of RC varied between hospitals of diagnosis and affected 2-year overall survival. Undergoing a RC was associated with age, cT-stage, socioeconomic status, type of hospital, and whether the hospital of diagnosis fulfilled the RC volume criteria. Future research is needed to identify patient, tumor, and hospital characteristics affecting utilization of curative treatment as this may benefit overall survival.
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Affiliation(s)
- Theodora M Ripping
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Lambertus A Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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24
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EDITORIAL COMMENT. Urology 2020; 143:192. [DOI: 10.1016/j.urology.2020.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 11/21/2022]
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25
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Onishi T, Sekito S, Shibahara T, Yabana T. Impact of noninvasive down-staging after transurethral resection of bladder tumor plus systemic chemotherapy on bladder-sparing strategy in patients with muscle-invasive bladder cancer. Urol Oncol 2020; 39:132.e1-132.e6. [PMID: 32792215 DOI: 10.1016/j.urolonc.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the optimal selection criteria for bladder sparing strategy with transurethral resection of bladder tumor (TURBT) and systemic chemotherapy in patients with muscle-invasive bladder cancer (MIBC). METHODS We conducted a retrospective cohort study in 71 patients with MIBC (T2-4aN0M0) who desire to bladder preservation received neoadjuvant chemotherapy (NAC) after maximal TURBT, followed by clinical restaging and second-TURBT. Fifty-eight of 71 patients with no residual tumor on the second-TURBT were placed on conservative management for bladder sparing (BS). Noninvasive down-staging (NID) was defined as cT0/Ta/Tis/T1N0 at first-TURBT after NAC and no residual tumor on second-TURBT. Overall survival (OS) and cystectomy-free survival (CFS) were assessed according to the response of NAC in the BS group by using Kaplan-Meier methods. Cox proportional hazards regression model was used to identify independent variables predicting OS. RESULTS At a median follow-up of 40 months 5-year OS and CFS in patients with NID and non-NID were 89.1% versus 20.8% and 84.8% versus 16.7%, respectively. Multivariate analysis showed that the ≥3 cycles of NAC (hazard ratio [HR] 0.14, 95% confidential index [CI] 0.03-0.7; P = 0.017) and achievement of NID (HR 0.11, 95% CI 0.03-0.46, P = 0.002) favorably associated with OS. CONCLUSIONS Patients who achieved NID might be optimal candidates for the bladder sparing strategy with maximum TURBT plus NAC followed by second-TURBT.
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Affiliation(s)
- Takehisa Onishi
- Department of Urology, Ise Red Cross hospital, Ise, Mie, Japan.
| | - Sho Sekito
- Department of Urology, Ise Red Cross hospital, Ise, Mie, Japan
| | | | - Tadashi Yabana
- Department of Pathology, Ise Red Cross hospital, Ise, Japan
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26
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Grajales V, Bandari J, Hale NE, Yabes JG, Turner RM, Fam MM, Sabik LM, Gingrich JR, Davies BJ, Jacobs BL. Associations Between Female Sex and Treatment Patterns and Outcomes for Muscle-invasive Bladder Cancer. Urology 2020; 151:169-175. [PMID: 32673679 DOI: 10.1016/j.urology.2020.06.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the association of female sex with the selected treatment for patients with nonmetastatic muscle-invasive bladder cancer. Sex is a known independent predictor of death from bladder cancer. A potential explanation for this survival disparity is difference in treatment pattern and stage presentation among males and females. MATERIALS AND METHODS Using the surveillance, epidemiology, and end results-medicare data set, we identified 6809 patients initially diagnosed with nonmetastatic muscle-invasive bladder cancer between 2004 and 2014. We fit multivariable logistic regression and Cox models to assess the relationship of sex with treatment modality and survival adjusting for differences in patient characteristics. RESULTS Of the 6809 patients with nonmetastatic muscle invasive bladder cancer, 2528 (37%) received a radical cystectomy while 4281 (63%) received an alternative bladder sparing intervention. Women were significantly more likely to receive a cystectomy (odds ratios [OR] 1.39; 95% confidence intervals [CI] 1.20-1.61), present at an older age with less comorbidities compared to men (P <.001). Women were also found to have worse bladder cancer-specific survival (CSS) than men (hazard ratio [HR] 1.18; 95% CI 1.05-1.32), no difference in overall survival (OS) (female HR 0.93; 0.86-1.01) and lower mortality from other causes (HR 0.78; 95% CI 0.70-0.86). There were no differences in OS and CSS by sex in patients with stage pT4a. CONCLUSION Female sex predicted more aggressive treatment with radical cystectomy yet worse cancer-specific survival than males. This sex disparity in CSS reduced the known OS advantage observed in women.
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Affiliation(s)
- Valentina Grajales
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nathan E Hale
- Department of Urology, Charleston Area Medical Center, Charleston, WV
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mina M Fam
- Coastal Urology Associates, Hackensack Meridian Health, Brick, NJ
| | - Lindsay M Sabik
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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27
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Psutka SP. Introduction: Personalizing risk stratification in bladder cancer: Moving away from "the eyeball test" and embracing objective quantification of risk. Urol Oncol 2020; 38:695-697. [PMID: 32600927 DOI: 10.1016/j.urolonc.2020.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah P Psutka
- Department of Urology, Seattle Cancer Care Alliance, University of Washington, Seattle, WA.
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28
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Golla V, Shan Y, Mehta HB, Klaassen Z, Tyler DS, Baillargeon J, Kamat AM, Freedland SJ, Gore JL, Chamie K, Kuo YF, Williams SB. Impact of Diagnosing Urologists and Hospitals on the Use of Radical Cystectomy. EUR UROL SUPPL 2020; 19:27-36. [PMID: 34337452 PMCID: PMC8317809 DOI: 10.1016/j.euros.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One out of five patients with muscle-invasive bladder cancer undergo radical cystectomy-a guideline-recommended treatment. Previous studies have primarily evaluated patient characteristics associated with the use of radical cystectomy, ignoring potential nesting of data. OBJECTIVE To determine the impact of patient, diagnosing urologist, and hospital characteristics on the variation in the use of radical cystectomy. DESIGN SETTING AND PARTICIPANTS This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results Registry (SEER)-Medicare linked database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A total of 7097 muscle-invasive bladder cancer patients and 4601 diagnosing urologists affiliated to 822 hospitals from January 1, 2002 to December 31, 2012 were analyzed. Multilevel logistic regression analyses were used to determine variation and factors associated with the use of radical cystectomy. RESULTS AND LIMITATIONS Of the 7097 patients, only 27% underwent radical cystectomy. The intraclass correlation coefficient for variation in the use of radical cystectomy attributed to the hospital level was 4.3%. Higher radical cystectomy volume by diagnosing urologists (more than five vs zero to one surgery: odds ratio [OR], 1.27; 95% confidence interval [CI], 1.00-1.62) and hospitals (more than five vs zero to four surgeries: OR,1.48; 95% CI, 1.14-1.93) was associated with increased use of radical cystectomy. Patients diagnosed by female rather than male urologists were more likely to undergo radical cystectomy (OR, 1.32; 95% CI, 1.07-1.62). CONCLUSIONS We found that 4.3% variation in the use of radical cystectomy was attributed to the hospital level, leaving 95.7% variation in use unexplained. We identified significantly increased use among higher-volume and female diagnosing urologists. These findings support further investigation into measures beyond hospital volume, which largely impact the utilization of radical cystectomy. PATIENT SUMMARY In this large population-based study, we found that 4.3% of variation in the use of radical cystectomy was attributed to the hospital level, leaving 95.7% variation in use unexplained. Higher radical cystectomy volume of diagnosing urologists and female urologists were independently associated with increased use of radical cystectomy. These findings support further investigation into measures beyond hospital volume, which largely impact the utilization of radical cystectomy.
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Affiliation(s)
- Vishnukamal Golla
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Yong Shan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hemalkumar B. Mehta
- Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
| | - Douglas S. Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ashish M. Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John L. Gore
- Department of Urology, The University of Washington, Seattle, WA, USA
| | - Karim Chamie
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Stephen B. Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
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Hamad J, McCloskey H, Milowsky MI, Royce T, Smith A. Bladder preservation in muscle-invasive bladder cancer: a comprehensive review. Int Braz J Urol 2020; 46:169-184. [PMID: 31961624 PMCID: PMC7025842 DOI: 10.1590/s1677-5538.ibju.2020.99.01] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 01/17/2023] Open
Abstract
Background Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients’ quality of life. Objective To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. Discussion The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. Conclusions This review highlights the breadth of strategies that aim to preserve a patient’s bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care.
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Affiliation(s)
- Judy Hamad
- University of North Carolina at Chapel Hill School of Medicine; Chapel Hill, NC, USA
| | - Hannah McCloskey
- 2 Department of Urology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
| | - Matthew I Milowsky
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
| | - Trevor Royce
- Department of Radiation Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
| | - Angela Smith
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
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30
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Plouvier SD, Bonnal JL, Machuron F, Colin P, Vankemmel O, Leroy X, Duhamel A, Villers A, Saint F, Pasquier D. Impact of age on bladder cancer management practices: a general population study. Acta Oncol 2020; 59:462-466. [PMID: 32043407 DOI: 10.1080/0284186x.2020.1723164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Jean-Louis Bonnal
- Service d’Urologie, Groupement des hôpitaux de l’Institut Catholique de Lille, Université nord de France
| | - François Machuron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Pierre Colin
- Service d'urologie, Hôpital privé La Louvière, Lille, France
| | | | - Xavier Leroy
- Department of Pathology, University of Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Arnauld Villers
- Department of Urology, University of Lille, CHU Lille, Lille, France
| | - Fabien Saint
- Department of Urology, University of Lille, CHU Lille, Lille, France
| | - David Pasquier
- Academic department of radiation oncology, Centre Oscar Lambret, Lille, France
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31
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Clinton TN, Wiseman M, Walasek A, Pietzak E. Commentary: underutilization of curative-intent therapy for patients with muscle-invasive bladder cancer in Sweden mimics the United States. Transl Androl Urol 2019; 8:S542-S545. [PMID: 32042642 PMCID: PMC6989840 DOI: 10.21037/tau.2019.12.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Timothy N Clinton
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michal Wiseman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aleksandra Walasek
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eugene Pietzak
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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32
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2019; 45:1090-1093. [PMID: 31808395 PMCID: PMC6909864 DOI: 10.1590/s1677-5538.ibju.2019.05.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Fernando Korkes
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Juan Palou
- Fundacion Puigvert Universitat Autonoma de Barcelona, Espanha
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33
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Korkes F, Palou J. High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients. Int Braz J Urol 2019. [PMID: 31808395 PMCID: PMC6909864 DOI: 10.1590/s1677-5538.ibju.2019.06.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Juan Palou
- Universitat Autonoma de Barcelona, Espanha
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34
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Aljabery F, Liedberg F, Häggström C, Ströck V, Hosseini A, Gårdmark T, Sherif A, Jerlström T, Malmström PU, Holmberg L, Hagberg O, Jahnson S. Management and outcome of muscle-invasive bladder cancer with clinical lymph node metastases. A nationwide population-based study in the bladder cancer data base Sweden (BladderBaSe). Scand J Urol 2019; 53:332-338. [DOI: 10.1080/21681805.2019.1681504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Viveka Ströck
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Abolfazl Hosseini
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per-Uno Malmström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- School of Medicine, King´s College London, London, UK
| | - Oskar Hagberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
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35
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Williams SB, Shan Y, Jazzar U, Mehta HB, Baillargeon JG, Huo J, Senagore AJ, Orihuela E, Tyler DS, Swanson TA, Kamat AM. Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer. JAMA Surg 2019; 153:881-889. [PMID: 29955780 DOI: 10.1001/jamasurg.2018.1680] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Importance Radical cystectomy is the guidelines-recommended treatment of muscle-invasive bladder cancer, but a resurgence of trimodal therapy has occurred. Limited comparative data are available on outcomes and costs attributable to these 2 treatments. Objective To compare the survival outcomes and costs between trimodal therapy and radical cystectomy in older adults with muscle-invasive bladder cancer. Design, Setting, and Participants This population-based cohort study used data from the Surveillance, Epidemiology, and End Results-Medicare linked database. A total of 3200 older adults (aged ≥66 years) with clinical stage T2 to T4a bladder cancer diagnosed from January 1, 2002, to December 31, 2011, and with claims data available through December 31, 2013, were included in the analysis. Patients who received radical cystectomy underwent either only surgery or surgery in combination with radiotherapy or chemotherapy. Patients who received trimodal therapy underwent transurethral resection of the bladder followed by radiotherapy and chemotherapy. Propensity score matching by sociodemographic and clinical characteristics was used. Data analysis was performed from August 1, 2017, to March 11, 2018. Main Outcomes and Measures Overall survival and cancer-specific survival were evaluated using the Cox proportional hazards regression model and the Fine and Gray competing risk model. All Medicare health care costs for inpatient, outpatient, and physician services within 30, 90, and 180 days of treatment were compared. The total amount spent nationwide was estimated, using 180-day medical costs between treatments, by the total number of new cases of muscle-invasive bladder cancer in the United States in 2011. Results Of the 3200 patients who met the inclusion criteria, 2048 (64.0%) were men and 1152 (36.0%) were women, with a mean (SD) age of 75.8 (6.0) years. After propensity score matching, 687 patients (21.5%) underwent trimodal therapy and 687 patients (21.5%) underwent radical cystectomy. Patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio [HR], 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83). No differences in costs at 30 days were observed between trimodal therapy ($15 233 in 2002 vs $18 743 in 2011) and radical cystectomy ($17 990 in 2002 vs $21 738 in 2011). However, median total costs were significantly higher with trimodal therapy than with radical cystectomy at 90 days ($80 174 vs $69 181; median difference, $8964; Hodges-Lehmann 95% CI, $3848-$14 079) and at 180 days ($179 891 vs $107 017; median difference, $63 771; Hodges-Lehmann 95% CI, $55 512-$72 029). Extrapolating these figures to the total US population revealed $335 million in excess spending for trimodal therapy compared with the less costly radical cystectomy ($492 million) for patients who received a muscle-invasive bladder cancer diagnosis in 2011. Conclusions and Relevance Trimodal therapy was associated with significantly decreased overall survival and cancer-specific survival as well as $335 million in excess spending in 2011. These findings have important health policy implications regarding the appropriate use of high value-based care among older adults with invasive bladder cancer who are candidates for either radical cystectomy or trimodal therapy.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Yong Shan
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Usama Jazzar
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Jacques G Baillargeon
- Sealy Center on Aging, Division of Epidemiology, Department of Medicine, The University of Texas Medical Branch, Galveston
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| | - Anthony J Senagore
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Eduardo Orihuela
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
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Luzzago S, Palumbo C, Rosiello G, Pecoraro A, Deuker M, Tian Z, Shariat SF, Saad F, Cobelli O, Karakiewicz PI. The effect of radical cystectomy on survival in patients with metastatic urothelial carcinoma of the urinary bladder. J Surg Oncol 2019; 120:1266-1275. [DOI: 10.1002/jso.25717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Stefano Luzzago
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
- Department of UrologyEuropean Institute of Oncology (IEO), IRCCSMilan Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
- Urology UnitDepartment of Medical and Surgical Specialties, Radiological Science and Public HealthASST Spedali Civili of BresciaUniversity of BresciaBrescia Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
- Department of Urology and Division of Experimental OncologyURI, Urological Research Institute, IRCCS San Raffaele Scientific InstituteMilan Italy
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
- Department of Urology, San Luigi Gonzaga HospitalUniversity of TurinTurin Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
- Department of UrologyUniversity Hospital FrankfurtFrankfurt Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
| | - Shahrokh F. Shariat
- Department of UrologyComprehensive Cancer CenterMedical University of ViennaVienna Austria
- Departments of UrologyWeill Cornell Medical CollegeNew York New York
- Department of UrologyUniversity of Texas SouthwesternDallas Texas
- Department of UrologySecond Faculty of MedicineCharles UniversityPrague Czech Republic
- Department of UrologyInstitute for Urology and Reproductive Health I.M. Sechenov First Moscow State Medical UniversityMoscow Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
| | - Ottavio Cobelli
- Department of UrologyEuropean Institute of Oncology (IEO), IRCCSMilan Italy
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilan Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes UnitDivision of UrologyUniversity of Montreal Health CenterMontreal Quebec Canada
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Williams SB, Shan Y, Ray-Zack MD, Hudgins HK, Jazzar U, Tyler DS, Freedland SJ, Swanson TA, Baillargeon JG, Hu JC, Kaul S, Kamat AM, Gore JL, Mehta HB. Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients With Localized Muscle-Invasive Bladder Cancer. JAMA Surg 2019; 154:e191629. [PMID: 31166593 DOI: 10.1001/jamasurg.2019.1629] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. Objective To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. Design, Setting, and Participants This population-based cohort study used the US Surveillance, Epidemiology, and End Results-Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2011. The data analysis was performed from March 5, 2018, through December 4, 2018. Main Outcomes and Measures Total Medicare costs within 1 year of diagnosis following radical cystectomy vs trimodal therapy were compared using inverse probability of treatment-weighted propensity score models that included a 2-part estimator to account for intrinsic selection bias. Results Of 2963 participants, 1030 (34.8%) were women, 2591 (87.4%) were white, 129 (4.4%) were African American, and 98 (3.3%) were Hispanic. Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83 754 vs $68 692; median difference, $11 805; 95% CI, $7745-$15 864), 180 days ($187 162 vs $109 078; median difference, $62 370; 95% CI, $55 581-$69 160), and 365 days ($289 142 vs $148 757; median difference, $109 027; 95% CI, $98 692-$119 363), respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On inverse probability of treatment-weighted adjusted analyses, patients undergoing trimodal therapy had $136 935 (95% CI, $122 131-$152 115) higher mean costs compared with radical cystectomy 1 year after diagnosis. Conclusions and Relevance Compared with radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. The differences in costs were largely attributed to medication and radiology expenses associated with trimodal therapy. Extrapolating cost figures resulted in a nationwide excess spending of $468 million for trimodal therapy compared with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Yong Shan
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Mohamed D Ray-Zack
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Hogan K Hudgins
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Usama Jazzar
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | | | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston
| | - Jacques G Baillargeon
- Sealy Center on Aging, Division of Epidemiology, Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - John L Gore
- Department of Urology, University of Washington, Seattle
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
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Regmi SK, Konety BR. Studying the impact of comorbidity on post radical cystectomy survival: have we come a full circle? Transl Androl Urol 2019; 8:S314-S317. [PMID: 31392156 DOI: 10.21037/tau.2019.06.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Subodh K Regmi
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
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Sung JM, Martin JW, Jefferson FA, Sidhom DA, Piranviseh K, Huang M, Nguyen N, Chang J, Ziogas A, Anton-Culver H, Youssef RF. Racial and Socioeconomic Disparities in Bladder Cancer Survival: Analysis of the California Cancer Registry. Clin Genitourin Cancer 2019; 17:e995-e1002. [PMID: 31239240 DOI: 10.1016/j.clgc.2019.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the California Cancer Registry (CCR) for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance in California patients. PATIENTS AND METHODS The CCR was queried for bladder cancer cases in California from 1988 to 2012. The primary outcome was disease-specific survival (DSS), defined as the time interval from date of diagnosis to date of death from bladder cancer. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors. RESULTS A total of 72,452 cases were included (74.5% men, 25.5% women). The median age was 72 years (range, 18-109 years). The racial distribution among the patients was 81% white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% from other races. In black patients, tumors presented more frequently with advanced stage and high grade. Medicaid patients tended to be younger and had more advanced-stage, higher-grade tumors compared to patients with Medicare or managed care (P < .0001). Kaplan-Meier analysis demonstrated significantly poorer 5-year DSS in black, low SES, and Medicaid patients (P < .0001). When controlling for stage, grade, age, and gender, multivariate analysis revealed that black race (DSS hazard ratio = 1.295; 95% confidence interval, 1.212-1.384), low SES (DSS hazard ratio = 1.325; 95% confidence interval, 1.259-1.395), and Medicaid insurance (DSS hazard ratio = 1.349; 95% confidence interval, 1.246-1.460) were independent prognostic factors (P < .0001). CONCLUSION An analysis of the CCR demonstrated that black race, low SES, and Medicaid insurance portend poorer DSS. These findings reflect a multifaceted socioeconomic and public health conundrum, and efforts to reduce inequalities should be pursued.
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Affiliation(s)
- John M Sung
- Department of Urology, University of California, Irvine, CA.
| | | | | | | | | | - Melissa Huang
- Department of Urology, University of California, Irvine, CA
| | - Nobel Nguyen
- Department of Urology, University of California, Irvine, CA
| | - Jenny Chang
- Department of Epidemiology, University of California, Irvine, CA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California, Irvine, CA
| | | | - Ramy F Youssef
- Department of Urology, University of California, Irvine, CA
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Williams SB, Ray-Zack MD, Hudgins HK, Oldenburg J, Trinh QD, Nguyen PL, Shore ND, Wirth MP, O'Brien T, Catto JWF. Impact of Centralizing Care for Genitourinary Malignancies to High-volume Providers: A Systematic Review. Eur Urol Oncol 2019; 2:265-273. [PMID: 31200840 PMCID: PMC10007401 DOI: 10.1016/j.euo.2018.10.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT The centralization of cancer care is associated with better clinical outcomes and may be a method for optimizing value-based health care systems. OBJECTIVE To systematically review the literature regarding the impact of centralization of care on clinical outcomes for genitourinary malignancies. EVIDENCE ACQUISITION A systematic review was conducted using Ovid and MEDLINE to identify studies between 1970 and 2018 reporting on the centralization of care for genitourinary malignancies. Prospective and retrospective studies were screened. EVIDENCE SYNTHESIS There were no published randomized control trials (RCTs) on the centralization of care for genitourinary malignancies. Twenty-two retrospective studies met inclusion criteria. Centralization of radical cystectomy was the most studied. Care for bladder cancer, prostate cancer, penile cancer, testicular cancer, and renal cancer was reportedly associated with better morbidity and survival outcomes for patients treated at high-volume centers. However, evidence of better outcomes for centralization of care remains limited for penile, renal, and testicular cancers owing to the paucity of data and/or the lower incidence of these genitourinary malignancies. CONCLUSIONS Care for genitourinary malignancies by high-volume providers was associated with greater utilization of cancer surgery, lower morbidity, and better survival outcomes. Centralization of care was most appropriate for complex procedures such as radical cystectomy when interpreted in the context of survival outcomes. Further research is needed to address the impact of centralizing care for all urologic malignancies with consideration of the associated costs and patient-reported measures, including quality of life and patient experience. PATIENT SUMMARY We explored the evidence for moving major operations into larger centers. We focused on surgery for cancers of the bladder, prostate, testicle, penis, and kidney, and found that larger-volume hospitals had better survival outcomes and fewer complications when compared to smaller hospitals. The difference may be greatest for complex major surgeries such as radical cystectomy.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hogan K Hudgins
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal D Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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Williams SB, Hudgins HK, Ray-Zack MD, Chamie K, Smaldone MC, Boorjian SA, Daneshmand S, Black PC, Kamat AM, Goebell PJ, Seiler R, Schmitz-Drager B, Nawroth R, Baillargeon J, Klaassen Z, Kulkarni GS, Kim SP, Lee EK, Holzbeierlein JM, Hollenbeck BK, Gore JL. Systematic Review of Factors Associated with the Utilization of Radical Cystectomy for Bladder Cancer. Eur Urol Oncol 2019; 2:119-125. [PMID: 31017086 PMCID: PMC10039463 DOI: 10.1016/j.euo.2018.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/03/2018] [Accepted: 07/19/2018] [Indexed: 01/09/2023]
Abstract
CONTEXT Despite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization. OBJECTIVE To systematically review the literature regarding factors associated with RC utilization. EVIDENCE ACQUISITION A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included. EVIDENCE SYNTHESIS There are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest. CONCLUSIONS RC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization. PATIENT SUMMARY In this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Hogan K Hudgins
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Marc C Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Siamak Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Peter C Black
- Department of Urologic Science, University of British Columbia, Vancouver, Canada
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Roland Seiler
- Department of Urology University Hospital Bern, Bern, Switzerland
| | | | - Roman Nawroth
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Jacques Baillargeon
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Zachary Klaassen
- Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Girish S Kulkarni
- Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Simon P Kim
- Urology Institute, Center for Health Care Quality and Outcomes, University Hospitals Case Western Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Eugene K Lee
- Department of Urology, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - John L Gore
- Department of Urology, The University of Washington, Seattle, WA, USA
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Kaag MG, Raman JD. Sarcopenia is a reliable predictor of outcomes following radical cystectomy for bladder cancer. Transl Androl Urol 2019; 7:S732-S734. [PMID: 30687610 PMCID: PMC6323275 DOI: 10.21037/tau.2018.09.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Matthew G Kaag
- Department of Surgery (Urology), Penn State Health, Hershey, PA, USA
| | - Jay D Raman
- Department of Surgery (Urology), Penn State Health, Hershey, PA, USA
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Gild P, Nguyen DD, Fletcher SA, Cole AP, Lipsitz SR, Kibel AS, Fisch M, Preston MA, Trinh QD. Contemporary Survival Rates for Muscle-Invasive Bladder Cancer Treated With Definitive or Non-Definitive Therapy. Clin Genitourin Cancer 2019; 17:e488-e493. [PMID: 30837209 DOI: 10.1016/j.clgc.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Definitive, curatively intended therapy for muscle-invasive bladder cancer can be associated with significant morbidity and adverse effects on quality of life, leaving patients reluctant to opt for these interventions. We sought to provide perspective to patients and clinicians exploring therapy options. MATERIALS AND METHODS We examined stage-by-stage overall survival of definitive therapy (DT) (either radical cystectomy in conjunction with neoadjuvant chemotherapy or trimodal therapy) versus non-DT (including palliative transurethral resection, chemotherapy and radiation treatment) among 42,144 patients within the National Cancer Database (2004-2012). RESULTS The median overall survival stratified by receipt of DT versus non-DT was 45.3 versus 16.4 months, 26.7 versus 9.6 months, and 21.2 versus 7.5 months in American Joint Committee on Cancer stages II, III, and IV, respectively. In multivariable Cox regression analysis, DT conferred a significant survival benefit in all stages, most pronounced in American Joint Committee on Cancer stage IV (hazard ratio, 0.46; 95% confidence interval, 0.43-0.49; P < .001). CONCLUSION Despite potentially significant morbidity and adverse effects on quality of life, DT is associated with a sizable survival benefit.
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Affiliation(s)
- Philipp Gild
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sean A Fletcher
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander P Cole
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark A Preston
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Ray-Zack MD, Shan Y, Mehta HB, Yu X, Kamat AM, Williams SB. Hospital length of stay following radical cystectomy for muscle-invasive bladder cancer: Development and validation of a population-based prediction model. Urol Oncol 2018; 37:837-843. [PMID: 30446462 DOI: 10.1016/j.urolonc.2018.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/15/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Length of hospital stay for patients following radical cystectomy is an important determinant for improved quality of care. We sought to develop and validate a predictive model for length of hospital stay following radical cystectomy. METHODS Patients aged 66 to 90 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer who underwent radical cystectomy were included from January 1, 2002 through December 31, 2011 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Linear regression analyses were used to develop and validate a predictive model for length of hospital stay. RESULTS A total of 2,448 patients met inclusion criteria. After random assignment, 1,224 patients were included in the discovery cohort and 1,224 patients included in the validation cohort. The cohorts were well balanced with no significant difference in any of the preoperative variables. A best model was developed using marital status, Surveillance, Epidemiology, and End Results (SEER) region, clinical stage, Charlson comorbidity index, logarithm of hospital cystectomy volume, and use of neoadjuvant chemotherapy in a backward selection to predict the length of stay. There was robust internal validation (sum square error (SSE): 258.1 vs. predicted sum of squares (PRESS): 264.0 at SLS = 0.10), consistent with the external validation (average square error (ASE): discovery (0.248) vs. validation (0.258)) cohort. The strength of the model in predicting length of stay for the entire cohort was (R2 = 0.048). CONCLUSION In this large population-based study, we developed and validated a model to predict length of hospital stay following radical cystectomy. Identification of at-risk patients for prolonged hospital stay may aid in targeted interventions to reduce length of stay, improve quality of care, and decrease healthcare costs.
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Affiliation(s)
- Mohamed D Ray-Zack
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Yong Shan
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Xiaoying Yu
- Department of Preventative Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX.
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Williams SB, Kamat AM, Chamie K, Froehner M, Wirth MP, Wiklund PN, Black PC, Steinberg GD, Boorjian SA, Daneshmand S, Goebell PJ, Pohar KS, Shariat SF, Thalmann GN. Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients. Eur Urol Oncol 2018; 1:91-100. [PMID: 30345422 DOI: 10.1016/j.euo.2018.03.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Context Radical cystectomy continues to be associated with a significant risk of morbidity and all-cause mortality (ACM). Practice pattern data demonstrating underuse of surgery for patients with muscle-invasive and high-risk non-muscle invasive bladder cancer (BC) have been linked to the advanced age and higher comorbidity status of such patients, which suggests that rates of ACM as well as cancer-specific mortality should be incorporated into patient counseling and guideline recommendations. Objective To review the literature on risk assessment tools for preoperative comorbidity in BC that may aid in treatment decision-making. Evidence acquisition A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on comorbidity risk assessment (CRA) tools for BC. Prospective and retrospective studies were included. Evidence synthesis There are no published randomized control trials comparing CRA tools for BC. Patients undergoing radical cystectomy with combined high-risk comorbidity and performance scores may face up to a sevenfold greater risk of other-cause mortality compared to those with low scores. The Charlson Comorbidity Index is one of the most widely studied indices for 90-d perioperative mortality and overall and cancer-specific survival, with an area under the receiver operating characteristic curve of up to 0.810. Prospective studies of CRA tools for BC have consistently shown that patients with higher comorbidity have worse outcomes. While not specific for BC, comorbidity indices provide useful assessment of competing risks. Competing-risks assessment tools are lacking, with limited studies assessing the impact of these tools on treatment decision-making by patients and providers. We provide the impetus for incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients. Conclusions CRA tools should be incorporated into preoperative treatment counseling and the assessment of postoperative outcomes. While retrospective evidence supports the use of CRA tools for BC, further comparative studies evaluating the effectiveness of these tools and identifying the patients most likely to benefit from a treatment according to competing-risks assessment are needed. Patient summary In this review we explored the clinical evidence for comorbidity risk assessment tools in bladder cancer. We found evidence to support incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter N Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter C Black
- Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada
| | - Gary D Steinberg
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | | | - Sia Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Kamal S Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
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46
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Zainfeld D, Shah A, Daneshmand S. Enhanced Recovery After Surgery Pathways: Role and Outcomes in the Management of Muscle Invasive Bladder Cancer. Urol Clin North Am 2018; 45:229-239. [PMID: 29650138 DOI: 10.1016/j.ucl.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radical cystectomy remains the gold standard therapy for the treatment of muscle-invasive urothelial carcinoma, yet is accompanied by significant rates of perioperative complications and readmission. Enhanced recovery protocols aim to apply evidence-based principles of care to ameliorate the morbidity of this procedure by enabling better tolerance of and recovery from radical cystectomy. Multiple patient series have demonstrated the capacity for enhanced-recovery-after-surgery (ERAS) principles to improve outcomes among patients undergoing radical cystectomy through decreased incidence of gastrointestinal complications and decreased length of hospitalization without increased readmissions or overall morbidity. Opportunities remain for adoption of established ERAS principles.
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Affiliation(s)
- Daniel Zainfeld
- Department of Urology, USC Keck/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA
| | - Ankeet Shah
- Department of Urology, USC Keck/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA
| | - Siamak Daneshmand
- Department of Urology, USC Keck/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA.
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Kim AH, Kim SP. Surviving travel or travelling to survive: the association of travel distance with survival in muscle invasive bladder cancer. Transl Androl Urol 2018; 7:S83-S85. [PMID: 29645020 PMCID: PMC5881221 DOI: 10.21037/tau.2018.01.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Albert H Kim
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Simon P Kim
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut, USA
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48
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Groeben C, Koch R, Baunacke M, Schmid M, Borkowetz A, Wirth MP, Huber J. Urinary Diversion After Radical Cystectomy for Bladder Cancer: Comparing Trends in the US and Germany from 2006 to 2014. Ann Surg Oncol 2018; 25:3502-3509. [DOI: 10.1245/s10434-018-6381-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Indexed: 11/18/2022]
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49
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Williams SB, Huo J, Chu Y, Baillargeon JG, Daskivich T, Kuo YF, Kosarek CD, Kim SP, Orihuela E, Tyler DS, Freedland SJ, Kamat AM. Cancer and All-cause Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy: Development and Validation of a Nomogram for Treatment Decision-making. Urology 2017; 110:76-83. [PMID: 28847688 DOI: 10.1016/j.urology.2017.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop and validate a nomogram assessing cancer and all-cause mortality following radical cystectomy. Given concerns regarding the morbidity associated with surgery, there is a need for incorporation of cancer-specific and competing risks into patient counseling and recommendations. MATERIALS AND METHODS A total of 5325 and 1257 diagnosed with clinical stage T2-T4a muscle-invasive bladder cancer from January 1, 2006 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked data, respectively. Cox proportional hazards models were used and a nomogram was developed to predict 3- and 5-year overall and cancer-specific survival with external validation. RESULTS Patients who underwent radical cystectomy were mostly younger, male, married, non-Hispanic white and had fewer comorbidities than those who did not undergo radical cystectomy (P < .001). Married patients, in comparison with their unmarried counterparts, had both improved overall (hazard ratio 0.76; 95% confidence interval 0.70-0.83, P < .001) and cancer-specific (hazard ratio 0.76; 95% confidence interval 0.68-0.85, P < .001) survival. A nomogram developed using Surveillance, Epidemiology, and End Results-Medicare data, predicted 3- and 5-year overall and cancer-specific survival rates with concordance indices of 0.65 and 0.66 in the validated Texas Cancer Registry-Medicare cohort, respectively. CONCLUSION Older, unmarried patients with increased comorbidities are less likely to undergo radical cystectomy. We developed and validated a generalizable instrument that has been converted into an online tool (Radical Cystectomy Survival Calculator), to provide a benefit-risk assessment for patients considering radical cystectomy.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, FL
| | - Yiyi Chu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacques G Baillargeon
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Yong-Fang Kuo
- Department of Medicine, Division of Biostatistics, Sealy Center on Aging, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Christopher D Kosarek
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Simon P Kim
- Urology Institute, Center for Health Care Quality and Outcomes, University Hospitals Case Western Medical Center, Case Western Reserve University, Cleveland, OH; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT
| | - Eduardo Orihuela
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Stephen J Freedland
- Department of Medicine, Division of Epidemiology, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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50
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Williams SB, Huo J, Dafashy TJ, Ghaffary CK, Baillargeon JG, Morales EE, Kim SP, Kuo YF, Orihuela E, Tyler DS, Freedland SJ, Kamat AM. Survival differences among patients with bladder cancer according to sex: Critical evaluation of radical cystectomy use and delay to treatment. Urol Oncol 2017. [PMID: 28647395 DOI: 10.1016/j.urolonc.2017.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Jinhai Huo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tamer J Dafashy
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Cameron K Ghaffary
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Jacques G Baillargeon
- Division of Epidemiology, Department of Medicine, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Edwin E Morales
- The Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Simon P Kim
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Yong-Fang Kuo
- Division of Biostatistics, Department of Medicine, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Eduardo Orihuela
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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