Population-based assessment of racial/ethnic differences in utilization of radical cystectomy for patients diagnosed with bladder cancer

被引:21
|
作者
Williams, Stephen B. [1 ]
Huo, Jinhai [2 ]
Kosarek, Christopher D. [1 ]
Chamie, Karim [3 ]
Rogers, Selwyn O., Jr. [4 ]
Williams, Michele A. [5 ]
Giordano, Sharon H. [2 ]
Kim, Simon P. [6 ]
Kamat, Ashish M. [7 ]
机构
[1] Univ Texas Med Branch, Div Urol, 301 Univ Blvd, Galveston, TX 77555 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Hlth Serv Res, Houston, TX 77030 USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, Dept Urol, Los Angeles, CA 90095 USA
[4] Univ Chicago, Dept Surg, 5841 S Maryland Ave, Chicago, IL 60637 USA
[5] Washington Univ, Sch Publ Hlth, St Louis, MO USA
[6] Case Western Reserve Med Ctr, Dept Urol, Cleveland, OH USA
[7] Univ Texas MD Anderson Canc Ctr, Dept Urol, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
Bladder cancer; Radical cystectomy; Lymph node dissection; Disparities Utilization; CHEMOTHERAPY; QUALITY; CARE;
D O I
10.1007/s10552-017-0902-2
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Radical cystectomy is a surgical treatment for recurrent non-muscle-invasive and muscle-invasive bladder cancer; however, many patients may not receive this treatment. Methods A total of 27,578 patients diagnosed with clinical stage I-IV bladder cancer from 1 January 2007 to 31 December 2013 were identified from the Surveillance, Epidemiology, and End Results SEER) registry database. We used multivariable regression analyses to identify factors predicting the use of radical cystectomy and pelvic lymph node dissection. Cox proportional hazards models were used to analyze survival outcomes. Results A total of 1,693 (6.1%) patients with bladder cancer underwent radical cystectomy. Most patients (92.4%) who underwent radical cystectomy also underwent pelvic lymph node dissection. When compared with white patients, non-Hispanic blacks were less likely to undergo a radical cystectomy [odds ratio (OR) 0.79, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. Moreover, recent year of surgery 2013 versus 2007 (OR 2.32, 95% CI 1.90-2.83, p<0.001),greater percentage of college education >= 36.3 versus <21.3% (OR 1.23, 95% CI 1.04-1.44, p = 0.013), Midwest versus West (OR 1.64, 95% CI 1.39-1.94, p < 0.001), and more advanced clinical stage III versus I (OR 29.1, 95% CI 23.9-35.3, p < 0.001) were associated with increased use of radical cystectomy. Overall survival was improved for patients who underwent radical cystectomy compared with those who did not undergo a radical cystectomy (hazard ratio 0.88, 95% CI 0.80-0.97, p = 0.008). Conclusion There is significant underutilization of radical cystectomy in patients across all age groups diagnosed with bladder cancer, especially among older, non-Hispanic black patients.
引用
收藏
页码:755 / 766
页数:12
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