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Häggström C, Rowley M, Liedberg F, Coolen ACC, Holmberg L. Latent heterogeneity of muscle-invasive bladder cancer in patient characteristics and survival: A population-based nation-wide study in the Bladder Cancer Data Base Sweden (BladderBaSe). Cancer Med 2023. [PMID: 37096787 DOI: 10.1002/cam4.5981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/13/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Patients with muscle-invasive bladder cancer (MIBC) constitute a heterogenous group in terms of patient and tumour characteristics ('case-mix') and prognosis. The aim of the current study was to investigate whether differences in survival could be used to separate MIBC patients into separate classes using a recently developed latent class regression method for survival analysis with competing risks. METHODS We selected all participants diagnosed with MIBC in the Bladder Cancer Data Base Sweden (BladderBase) and analysed inter-patient heterogeneity in risk of death from bladder cancer and other causes. RESULTS Using data from 9653 MIBC patients, we detected heterogeneity with six distinct latent classes in the studied population. The largest, and most frail class included 50% of the study population and was characterised by a somewhat larger proportion of women, higher age at diagnosis, more advanced disease and lower probability of curative treatment. Despite this, patients in this class treated with curative intent by radical cystectomy or radiotherapy had a lower association to risk of death. The second largest class included 23% and was substantially less frail as compared to the largest class. The third and fourth class included each around 9%-10%, whereas the fifth and sixth class included each 3%-4% of the population. CONCLUSIONS Results from the current study are compatible with previous research and the method can be used to adjust comparisons in prognosis between MIBC populations for influential differences in the distribution of sub-classes.
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Affiliation(s)
- Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå University, Umeå, Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Mark Rowley
- Saddle Point Science, York, UK
- Saddle Point Science Europe, Nijmegen, The Netherlands
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anthony C C Coolen
- Saddle Point Science, York, UK
- Saddle Point Science Europe, Nijmegen, The Netherlands
- Department of Biophysics, Faculty of Science, Donders Institute, Radboud University, Nijmegen, The Netherlands
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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Rutherford MJ, Andersson TML, Myklebust TÅ, Møller B, Lambert PC. Non-parametric estimation of reference adjusted, standardised probabilities of all-cause death and death due to cancer for population group comparisons. BMC Med Res Methodol 2022; 22:2. [PMID: 34991487 PMCID: PMC8740504 DOI: 10.1186/s12874-021-01465-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Ensuring fair comparisons of cancer survival statistics across population groups requires careful consideration of differential competing mortality due to other causes, and adjusting for imbalances over groups in other prognostic covariates (e.g. age). This has typically been achieved using comparisons of age-standardised net survival, with age standardisation addressing covariate imbalance, and the net estimates removing differences in competing mortality from other causes. However, these estimates lack ease of interpretability. In this paper, we motivate an alternative non-parametric approach that uses a common rate of other cause mortality across groups to give reference-adjusted estimates of the all-cause and cause-specific crude probability of death in contrast to solely reporting net survival estimates. METHODS We develop the methodology for a non-parametric equivalent of standardised and reference adjusted crude probabilities of death, building on the estimation of non-parametric crude probabilities of death. We illustrate the approach using regional comparisons of survival following a diagnosis of rectal cancer for men in England. We standardise to the covariate distribution and other cause mortality of England as a whole to offer comparability, but with close approximation to the observed all-cause region-specific mortality. RESULTS The approach gives comparable estimates to observed crude probabilities of death, but allows direct comparison across population groups with different covariate profiles and competing mortality patterns. In our illustrative example, we show that regional variations in survival following a diagnosis of rectal cancer persist even after accounting for the variation in deprivation, age at diagnosis and other cause mortality. CONCLUSIONS The methodological approach of using standardised and reference adjusted metrics offers an appealing approach for future cancer survival comparison studies and routinely published cancer statistics. Our non-parametric estimation approach through the use of weighting offers the ability to estimate comparable survival estimates without the need for statistical modelling.
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Affiliation(s)
- Mark J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK.
| | | | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Paul C Lambert
- Department of Health Sciences, University of Leicester, Leicester, UK
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Ripoll J, Ramos M, Montaño J, Pons J, Ameijide A, Franch P. Cancer-specific survival by stage of bladder cancer and factors collected by Mallorca Cancer Registry associated to survival. BMC Cancer 2021; 21:676. [PMID: 34098901 PMCID: PMC8186217 DOI: 10.1186/s12885-021-08418-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
Background Information about survival by stage in bladder cancer is scarce, as well as about survival of non-invasive bladder cancer. The aims of this study are: 1) to find out the distribution of bladder cancer by stage; 2) to determine cancer-specific survival by stage of bladder cancer; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers. Methods Incident bladder cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with code C67 according to the ICD-O 3rd edition with any behaviour and any histology, except lymphomas and small cell carcinomas. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis. Results One thousand nine hundred fourteen cases were identified. 14% were women and 65.4% were 65 years or older. 3.9% had no stage (benign or undetermined behaviour) and 11.5% had unknown stage. After MI, 37.5% were in stage Ta (non-invasive papillary carcinoma), 3.2% in stage Tis (carcinoma in situ), 34.3% in stage I, 11.7% in Stage II, 4.3% in stage III, and 9.0% in stage IV. Survival was 76% at 5 years. Survival by stage: 98% at stage Ta, 90% at stage Tis, 85% at stage I, 45% at stage II, 35% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage, but not sex, were associated with survival. Conclusion Bladder cancer survival vary greatly with stage, among both non-invasive and invasive cases. The percentage of non-invasive cancers is high. Stage, age, and histology are associated to survival.
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Affiliation(s)
- J Ripoll
- Primary Care Research Unit of Mallorca, Balearic Health Service, Palma, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, 07120, Illes Balears, Spain
| | - M Ramos
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, 07120, Illes Balears, Spain. .,Mallorca Cancer Registry, Balearic Islands Public Health Department, Palma, Spain.
| | - J Montaño
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, 07120, Illes Balears, Spain.,University of the Balearic Islands, Palma, Spain
| | - J Pons
- Mallorca Cancer Registry, Balearic Islands Public Health Department, Palma, Spain
| | - A Ameijide
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service. Sant Joan de Reus University Hospital, IISPV., Reus, Spain
| | - P Franch
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, 07120, Illes Balears, Spain.,Mallorca Cancer Registry, Balearic Islands Public Health Department, Palma, Spain
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Temporal trends in net and crude probability of death from cancer and other causes in the Australian population, 1984-2013. Cancer Epidemiol 2019; 62:101568. [PMID: 31330423 DOI: 10.1016/j.canep.2019.101568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND While net probabilities of death in the relative survival framework ignore competing causes of death, crude probabilities allow estimation of the real risk of cancer deaths. This study quantifies temporal trends in net and crude probabilities of death. METHODS Australian population-based cohort of 2,015,903 people aged 15-89 years, diagnosed with a single primary invasive cancer from 1984 to 2013 with mortality follow-up to 31 December 2014. Survival was analyzed with the cohort method. Flexible parametric relative survival models were used to estimate both probability measures by diagnosis year for all cancers and selected leading sites. RESULTS For each site, excess mortality rates reduced over time, especially for prostate cancer. While both the 10-year net and crude probability of cancer deaths decreased over time, specific patterns varied. For example, the crude probability of lung cancer deaths for males aged 50 years decreased from 0.90 (1984) to 0.79 (2013); whereas the corresponding probabilities for kidney cancer were 0.64 and 0.18 respectively. Patterns for crude probabilities of competing deaths were relatively constant. Although for younger patients, both net and crude measures were similar, crude probability of competing deaths increased with age, hence for older ages net and crude measures were different except for lung and pancreas cancers. CONCLUSIONS The observed reductions in probabilities of death over three decades for Australian cancer patients are encouraging. However, this study also highlights the ongoing mortality burden following a cancer diagnosis, and the need for continuing efforts to improve cancer prevention, diagnosis and treatment.
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Bladder cancer survival: Women better off in the long run. Eur J Cancer 2018; 95:52-58. [DOI: 10.1016/j.ejca.2018.03.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 11/20/2022]
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Dehayni Y, Tetou M, Khdach Y, Janane A, Alami M, Ameur A. [Prognostic of older age for patients with invasive-muscle-bladder cancer and treated by radical cystectomy]. Prog Urol 2018; 28:166-172. [PMID: 29329898 DOI: 10.1016/j.purol.2017.12.005] [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: 05/02/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Bladder tumor is a disease of older persons, but can also occur in young adults, because certainly an influence of environmental factors and a change of lifestyle. The aim of our retrospective analysis is to assess and evaluate the extent of the prognostic impact of age on the carcinological prognosis of invasive-muscle-bladder cancer treated by total cystotomy. METHODS To evaluate the association of patient age with pathological characteristics and recurrence-free and disease survival, we retrospectively reviewed 345 patients with invasive bladder cancer between January 2000 and January 2015. RESULTS We divided our patients into two groups: patients under 65 years of age=150 cases (group 1), patients aged 65 years and over=195 cases (group 2). The 3-year survival rates for patients according to the age groups were 88% and 64% respectively, end the recurrence-free survival 66% and 28%. When age was analysed as a categorical variable, was associated with hydronephrosis (P=0.001), advanced pathological stage (P=0.034), high grade (P=0.026), nodal involvement (P=0.011) and lymphovascular invasion (P=0.008). The multivariate Cox model analysis showed that hydronephrosis and pathological stage was prognostic factors of survival (P=0.012 and P=0.035, respectively). Higher age is significantly associated with the risk of pathologically advanced disease and poorer global survival. CONCLUSION This work allowed us to assert that advanced chronological age is significantly associated with an advanced pathological stage of the disease (volume, pT, grade, lymph nodes) and a low overall survival rate. This could be useful for selecting subjects who would require adjuvant therapy, as well as for planning early complementary therapies. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Y Dehayni
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc.
| | - M Tetou
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - Y Khdach
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - A Janane
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - M Alami
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
| | - A Ameur
- Service d'urologie de l'hôpital militaire d'instruction Mohamed V, Rabat, Maroc
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Dutheil F, Rouanet L, Mulliez A, Naughton G, Fontana L, Druet-Cabanac M, Moustafa F, Chamoux A. Urine cytology screening of French workers exposed to occupational urinary tract carcinogens: a prospective cohort study over a 20-year period. BMJ Open 2017; 7:e016238. [PMID: 28939575 PMCID: PMC5623560 DOI: 10.1136/bmjopen-2017-016238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To demonstrate that urine cytology screening can provide relevant epidemiological data for earlier detection of urothelial cancer caused by occupational exposure. DESIGN Prospective cohort study. SETTING Industries using urothelial carcinogens in France. Urine samples were collected on site, after a work week and were analysed at the University Hospital of Clermont-Ferrand, France. PARTICIPANTS Participants were workers exposed to urothelial carcinogens. Women and current smokers at time of study recruitment were exclusion criteria. OUTCOMES Urine cells atypia were ranged into three classes: negative/normal, atypical/suspicious/dysplasia or positive/malignant. RESULTS We included 2020 workers over a period of 20 years from 1993 to 2013: 606 worked in rubber manufacturing, 692 from metal processing, 245 in chemical industry and 477 in roadwork and building industry. Workers had a mean exposure of 15.2±10.4 years before their first urine cytology screening. There was a mean of 3.4±4.3 urine cytology screenings per worker between 1993 and 2013. 6478 cytology were normal, 462 suspicious and 13 malignant. Suspicious and malignant cytology occurred in 4.8% of workers exposed for 1-10 years, 6.2% for 11-20 years of exposure, 7.6% for 21-30 years and 8.6% for >30 years (p<0.001). Using exposure for 1-10 years as reference, the adjusted OR of receiving a suspicious or malignant diagnosis increased with duration of exposure: OR=1.50 (95% CI 1.10 to 2.05, p=0.01) for 21-30 years and OR=1.78 (95% CI 1.23 to 2.56, p=0.002) for >30 years of exposure. Using metal processing as reference, the risk of pathological urine cytology results increased for rubber manufacturing (OR=1.32, 95% CI 1.05 to 1.65, p=0.02), with a trend for roadwork and building industry (OR=1.39, 95% CI 0.98 to 1.97, p=0.07) and for chemical industry (OR=1.34, 95% CI 0.94 to 1.93, p=0.11). CONCLUSIONS Urine cytology is a useful tool in occupational medicine. We promote new guidelines with an early screening of urothelial cancer by cytology, starting with beginning of exposure.
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Affiliation(s)
- Frederic Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Clermont-Ferrand, France
- Faculty of Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Lucile Rouanet
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Clinical Research Direction, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | | | - Luc Fontana
- Faculty of Medicine Jacques-Lisfranc, University Jean-Monnet, Saint-Etienne, France
- Department of Preventive and Occupational Medicine, University Hospital of Saint-Etienne, CHU Saint-Etienne, Saint-Etienne, France
- UMR T9405, UMRESTTE (IFSTTAR-UCBL), University Lyon 1, Domaine Rockefeller, Lyon, France
| | - Michel Druet-Cabanac
- CNRS 3503 GEIST, INSERM UMR s1094, Tropical Neuroepidemiology, University Hospital of Limoges, CHU Limoges, Preventive and Occupational Medicine, Limoges, France
| | - Farès Moustafa
- Emergency Department, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Alain Chamoux
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand, CHU-Clermont-Ferrand, Clermont-Ferrand, France
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