Rates of other‐cause mortality after radical cystectomy are decreasing over time—A population‐based analysis over two decades

Abstract

Background and Objectives: To investigate other-cause mortality (OCM) rates over time according to several baseline characteristics in bladder cancer (BCa) patients treated with radical cystectomy (RC). Methods: Within the Surveillance, Epidemiology, and End Results database (1988-2011), we identified 7702 T 1-2 N 0 M 0 urothelial BCa patients treated with RC. Temporal trends and multivariable Cox regression (MCR) analyses assessed 5-year OCM. Data were stratified according to the year of diagnosis (), age group (<60 vs 60-75 vs >75 years), sex, race, marital status, and socioeconomic status. Results: Overall, OCM rates decreased from 13.9% in 1988-1995 to 8.6% in 2009-2011. The greatest decrease was recorded in elderly (>75) patients (32%-16%, slope: −0.55% per year; P = .01), followed by patients aged 60 to 75 (21%-5%, slope: −0.35% per year; P = .01), unmarried patients (16%-10%, slope: −0.26% per year; P < .001), male patients (14%-8.9%, slope: −0.23% per year), and African Americans (16%-11%, slope: −0.27% per year; P < .001). MCR models corroborated these results.Conclusions: Most important decrease in OCM after RC over the last decades was recorded in the elderly, unmarried, and male patients. Nonetheless, these three patient groups still represent ideal targets for efforts aimed at minimizing the morbidity and mortality after RC, as their risk of OCM is higher than in others. K E Y W O R D Sbladder cancer, competing risk, elderly, risk factors, SEER database

Long-term oncologic outcomes of robot-assisted radical cystectomy: update series from a high-volume robotic center beyond 10 years of follow-up

“…For instance, using the Surveillance, Epidemiology, and End Results (SEER) registries, Lughezzani et al described survival outcomes of 11,260 patients treated with radical cystectomy between 1988 and 2006. They found cancer-specific mortality to be the main cause of mortality regardless of disease stage and age, with a CSM-free survival ranging from 18 to 67% five years after surgery [24], a finding that was confirmed by a subsequent investigations [25]. However, population-based registries may suffer from inherent limitations that may include a lack of data on indications for neoadjuvant and/ or adjuvant therapies, variables that are not included in the SEER database.…”

“…After a median follow-up of 6 years, they showed a 10-year cumulative incidence of cancer-specific and other-cause mortality of 52% and 23%, respectively. Other series described similar survival rates [8], but were somewhat limited but their design (i.e., population-based registries [24,25]), limited followup after surgery [26] or small sample size [8]. By contrast, we here provided the largest series on RARC with mature follow-up, including detailed analyses of cause-specific 4 Cumulative incidence functions of death from bladder cancer (solid line), death from other causes (dashed), and all-cause mortality (dotted) after robotic radical cystectomy mortality rates.…”

Decreasing Non–bladder-cancer Mortality After Radical Cystectomy

“…Decreasing other-cause mortality after RC has been observed in a population-based study of US patients treated between 1988 and 2011, particularly for elderly, unmarried, and male patients [6] . In our study, competing mortality decreased over time in all subgroups ( Table 2 ).…”

“…Decreasing competing mortality might shift this limit to older ages in the future. It has been hypothesized that decreasing other-cause mortality after RC may reflect better patient selection and might represent a positive quality indicator [6] . The results of our study do not support this hypothesis.…”

Design of a novel instrument for cold excision of bladder tumors under local anesthesia

“…Treatment for muscle invasive bladder cancer is mainly based on total bladder resection, while treatment for non-muscle invasive bladder is mostly based on local resection. The development of new drugs for bladder tumors has allowed bladder preservation for a signi cant proportion of patients with muscle invasive bladder cancer [4]. Current surgical resection modalities for non-muscle invasive bladder cancer and bladder-preserving invasive bladder cancer include plasma electrosurgery and laser resection [5][6].…”