Cancer and All-Cause Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy: Development and Validation of a Nomogram for Treatment Decision-Making: Beyond the Abstract
Brief summary of our findings:
Bladder cancer represents a lethal disease once it invades the muscle. Treatments include radical cystectomy which is associated with a non-negligible risk of morbidity and all-cause mortality. These concerns, as well as prior reports concerning underuse due to advanced age and increased comorbidities, suggest cancer-specific as well as all-cause mortality rates. Taking these determinants, as well as tumor-related factors, into account should be incorporated into patient counseling and guideline recommendations.
A total of 5,325 and 1,257 diagnosed with clinical stage T2-T4a muscle-invasive bladder cancer from January 1, 2006 to December 31, 2011 from SEER-Medicare (discovery cohort) and Texas Cancer Registry (TCR)-Medicare (validation cohort) 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.
In the discovery cohort, older age at diagnosis (>80 vs 66-69 years old, HR 1.63; 95% CI, 1.47 to 1.81, p<0.001), higher comorbidity (Charlson comorbidity index 3+ vs 0, HR 1.68; 95% CI, 1.53-1.85, p<0.001) and non-Hispanic black vs. white patients (HR 1.28; 95% CI, 1.12 to 1.45, p<0.001) were associated with decreased overall survival. Similar findings for cancer-specific survival persisted. A nomogram developed using SEER-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 TCR-Medicare cohort, respectively.
Written by: Stephen B. Williams, The University of Texas Medical Branch
Read the Abstract