A comparison of patient and tumour characteristics in two UK bladder cancer cohorts separated by 20 years

Abstract

Objectives To compare patient and tumour characteristics at presentation from two large bladder cancer cohorts, with recruitment separated by 15–20 years To identify significant differences in the West Midlands' urothelial cancer of the bladder (UCB) population during this period. Patients and Methods Data were collected prospectively from 1478 patients newly diagnosed with UCB in the West Midlands from January 1991 to June 1992 (Cohort 1), and from 1168 patients newly diagnosed with UBC within the same region from December 2005 to April 2011 (Cohort 2). Gender, age, smoking history, and tumour grade, stage, type, multiplicity and size at presentation were compared using a Pearson chi‐square test or Cochran–Armitage trend test, as appropriate. Result Cohort 2 had a higher proportion of male patients (P = 0.021), elderly patients (P < 0.001), grade 3 tumours (P < 0.001), Ta/T1 tumours (P = 0.008), multiple tumours (P < 0.001), and tumours of ≤2 cm in diameter (P < 0.001). Conclusions There were significant differences between the cohorts. These differences are potentially explained by an ageing population, changes in grading practices, improved awareness of important symptoms, improved cystoscopic technology, and reductions in treatment delays. Regional cohorts remain important for identifying changes in tumour and patient characteristics that may influence disease management in the UK and beyond.

Cell adhesion and urothelial bladder cancer: the role of cadherin switching and related phenomena

“…These findings have important implications for the clinical management of MIBC: they include not only prognostic information, but also suggestions for subtypedirected targeted therapy and potential to predict response to cisplatin-based chemotherapy (although further work is needed to elucidate other biomarkers of resistance) [55]. It is, however, disappointing that NMIBCs were not analysed in the same way by either the TCGA Research Network or Choi et al [47], especially as these tumours represent the vast majority (more than 75%) of bladder cancer patients [56,57].…”

Urothelial Carcinoma of the Bladder in Swedish Geriatric Patients: A Population-based Study

“…7 In another study assessing a cohort of 1168 patients diagnosed with UBC in England between 2005 and 2011, the median age at presentation was 75 years for women and 73 years for men. 8 A Swedish report has shown age-related differences in the treatment of muscle-invasive bladder cancer, 9 and it would be unsurprising if similar mechanisms could explain some of the age-related differences in patients with T1 UBC. On the other hand it can be argued that the expected lifespan for men and women normally differs with 3 to 4 years in favour of women, which would make the under treatment of women even more profound.…”

Update on bladder cancer diagnosis and management

“…Since 75-80 per cent of patients present with NMIBC, where recurrence and progression are significant issues, 3,9,16,17 current guidelines recommend long-term surveillance with regular outpatient flexible cystoscopy. 7 Consequently, bladder cancer is one of the most expensive malignancies to manage on a per-patient basis from diagnosis to death, 18 and this has led to over a decade of diagnostic urinary biomarker research in an attempt to overcome the cost and invasive nature of NMIBC surveillance.…”

“…Recent data suggest that chemotherapy-radiotherapy regimens can achieve long-term outcomes that rival those achieved with neoadjuvant chemotherapy and radical cystectomy. 12 Chemoradiotherapy is thus a viable alternative to neoadjuvant chemotherapyradical cystectomy, and this is particularly relevant for the rapidly growing proportion of over 80-year-old patients diagnosed with MIBC, 9 for whom the 90-day mortality rates for radical cystectomy are significantly greater than those for younger patients. 26 In reality, data demonstrate that the majority of over 80-year-old patients diagnosed with MIBC in the UK are treated with radiotherapy, although experts consider that cystectomy in this group is safe when carried out in selected patients in specialist high-volume units, and utilising enhanced recovery programmes.…”