@Article{,
AUTHOR = {Joshua S. Jue, Tulay Koru-Sengul, Kevin J. Moore, Feng Miao, Mahmoud Alameddine, Bruno Nahar, Sanoj Punnen, Dipen J. Parekh, Chad R. Ritch, Mark L. Gonzalgo},
TITLE = {Sociodemographic and survival disparities for histologic variants of bladder cancer},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {25},
YEAR = {2018},
NUMBER = {1},
PAGES = {9179--9185},
URL = {http://www.techscience.com/CJU/v25n1/60885},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> To investigate the impact of perioperative factors on overall survival among patients with histologic variants of bladder cancer treated with radical cystectomy.<br/>

<b>Materials and methods:</b> 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.<br/>

<b>Results:</b> 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).<br/>

<b>Conclusions:</b> 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.},
DOI = {}
}