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Muscle‐invasive bladder cancer: evaluating treatment and survival in the N ational C ancer D ata B ase
Author(s) -
Smith Angela B.,
Deal Allison M.,
Woods Michael E.,
Wallen Eric M.,
Pruthi Raj S.,
Chen Ronald C.,
Milowsky Matthew I.,
Nielsen Matthew E.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12601
Subject(s) - cystectomy , medicine , hazard ratio , bladder cancer , proportional hazards model , radiation therapy , urology , confidence interval , oncology , cohort , survival analysis , cancer , surgery
Objective To evaluate the association between patterns of care and patient survival for the treatment of muscle‐invasive bladder cancer ( MIBC ) using a large, national database. Patients and Methods We identified a cohort of 36 469 patients with MIBC (stage II ) from 1998 to 2010 from the N ational C ancer D ata B ase. Patients were stratified into four treatment groups: radical cystectomy, chemo‐radiation, other therapy, or no treatment. Overall survival ( OS ) among the groups was evaluated using K aplan– M eier analysis and the log rank test. A multivariable C ox proportional hazards model was fit to evaluate the association between treatment groups and OS . Results In all, 27% of patients received radical cystectomy, 10% chemo‐radiation, 61% other therapy and 2% no treatment. Unadjusted K aplan– M eier analysis showed significant differences by treatment group, with cystectomy having the greatest median OS (48 months) followed by chemo‐radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, the OS for cystectomy was similar to that for chemo‐radiation (hazard ratio [ HR ] 1.05, 95% confidence interval [ CI ] 0.98, 1.12), but superior to other therapy ( HR 1.42; 95% CI 1.35, 1.48), and no treatment ( HR 2.40; 95% CI 2.12, 2.72). The OS time for chemo‐radiation was superior to other therapy and no treatment. Conclusions Radical cystectomy and chemo‐radiation are significantly underused despite a substantial survival benefit compared with other therapies or no treatment. Future studies are needed to optimise care delivery and improve outcomes for patients with MIBC .