Open Access

ARTICLE

Sociodemographic and survival disparities for histologic variants of bladder cancer

Joshua S. Jue^1,2, Tulay Koru-Sengul^3,4, Kevin J. Moore^2,3, Feng Miao², Mahmoud Alameddine¹, Bruno Nahar¹, Sanoj Punnen¹, Dipen J. Parekh^1,4, Chad R. Ritch¹, Mark L. Gonzalgo^1,4

1 Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
2 Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
3 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
4 Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
Address correspondence to Dr. Mark L. Gonzalgo, Department of Urology, University of Miami – Miller School of Medicine, 1120 NW 14th Street, Suite 1560, Miami, FL 33136 USA

Canadian Journal of Urology 2018, 25(1), 9179-9185.

Abstract

Introduction: To investigate the impact of perioperative factors on overall survival among patients with histologic variants of bladder cancer treated with radical cystectomy.
Materials and methods: The National Cancer Data Base (NCDB) was utilized to identify patients diagnosed with muscle-invasive bladder cancer (cT2–T4, N0, M0) from 2004 to 2013. Variant histology bladder cancers—including non-mucinous adenocarcinoma, mucinous/signet ring adenocarcinoma, micropapillary urothelial carcinoma, small cell carcinoma, and squamous cell carcinoma—were compared to urothelial carcinoma with respect to overall survival. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using a multivariable Cox regression model to examine factors affecting overall survival, T upstaging, N upstaging, and positive surgical margins. Median survival was estimated using Kaplan-Meier analysis.
Results: A total of 5,856 patients were included in this study. Significant predictors of worse overall survival included African-American ancestry (aHR = 1.24, 95% CI: 1.03–1.48, p = 0.021), age (aHR = 1.03, 95% CI: 1.02–1.03, p < 0.001), comorbidity (aHR = 1.30, 95% CI: 1.20–1.40, p < 0.001), clinical T3 stage (aHR = 1.41, 95% CI: 1.26–1.57, p < 0.001), and clinical T4 stage (aHR = 1.59, 95% CI: 1.38–1.84, p < 0.001). Small cell carcinoma (aHR = 2.10, 95% CI: 1.44–3.06, p < 0.001) and non-mucinous adenocarcinoma (aHR = 1.59, 95% CI: 1.15–2.20, p = 0.005) were significant predictors of worse overall survival compared to urothelial carcinoma. Small cell carcinoma had the worst 5-year overall survival rate (15.5%, 95% CI: 5.2%–30.9%), compared to urothelial carcinoma (48.7%, 95% CI: 47.2%–50.2%). Micropapillary urothelial carcinoma was significantly associated with increased risk of nodal positivity and positive surgical margins after radical cystectomy compared to urothelial carcinoma (aHR = 6.01, 95% CI: 3.11–11.63, p < 0.001; aHR = 4.38, 95% CI: 2.05–9.38, p < 0.001).
Conclusions: Among bladder cancer patients with equal treatment and staging, small cell carcinoma and non-mucinous adenocarcinoma variant histologies were associated with worse overall survival compared to urothelial carcinoma. Patient demographic factors such as African-American ancestry and older age were also independent predictors of poorer survival outcomes in both variant histology bladder cancer and urothelial carcinoma.

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