TY - JOUR
T1 - Survival by T Stage for Patients with Localized Bladder Cancer
T2 - Implications for Future Screening Trials
AU - Folgosa Cooley, Lauren
AU - Weiner, Adam B.
AU - Meng, Xiaosong
AU - Woldu, Solomon L.
AU - Meeks, Joshua J.
AU - Lotan, Yair
N1 - Publisher Copyright:
© 2021-The authors. Published by IOS Press.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: There is insufficient data to recommend screening for bladder cancer (BC). For future BC screening trials, it is important to understand how and if tumor (T) stage can act as a surrogate outcome marker for overall (OS) and cancer-specific (CSS) survival. OBJECTIVE: To characterize OS and CSS between primary tumor (T) stages in non-metastatic bladder cancer (BC) patients. METHODS: Non-metastatic BC patients were identified in the National Cancer Database (NCDB; 2004-2015) (n = 343,163) and National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER) (n = 130,751). Cox multivariable regression compared relationships between T stage (LGTa, HGTa, Tis, LGT1, HGT1, T2-T4) and OS or CSS for all patients and sub-cohorts. RESULTS: Compared to stage LGTa as a reference, overall (SEER; NCDB) and cancer-specific (SEER) survival significantly declined with increasing T stage. Using SEER, OS ranged from HGTa (HR 1.16, CI 1.13-1.21, p < 0.001) to T4 (HR 5.70, CI 5.41-6.00, p < 0.001) with a steep inflection between HGT1 (HR 1.68, CI 1.63-1.73, p < 0.001) and T2 (HR 3.39, CI 3.30-3.49, p < 0.001), which was verified with NCDB. The association of stage and CSS was even more pronounced: HGTa (84% 10 year-CSS, HR 1.94, CI 1.81-2.08, p < 0.001), Tis (82% 10 year-CSS, HR 2.28, CI 2.09-2.47, p < 0.001), LGT1 (84% 10 year-CSS, HR 2.30, CI 2.11-2.51, p < 0.001), HGT1 (72% 10 year-CSS, HR 4.24, CI 4.01-4.47, p < 0.001), T2 (48% 10 year-CSS, HR 12.18, CI 11.57-12.82, p < 0.001), T3 (45% 10 year-CSS, HR 14.60, CI 13.63-15.64, p < 0.001), and T4 (29% 10 year-CSS, HR 22.76, CI 21.19-24.44, p < 0.001). CONCLUSIONS: Earlier T stage at diagnosis was associated with better OS largely due to differences in CSS. A clinically significant difference between Stage I and Stage II was verified herein in multiple cohorts. Therefore, earlier stage at diagnosis, specifically preventing muscle invasive BC, could potentially improve survival.
AB - BACKGROUND: There is insufficient data to recommend screening for bladder cancer (BC). For future BC screening trials, it is important to understand how and if tumor (T) stage can act as a surrogate outcome marker for overall (OS) and cancer-specific (CSS) survival. OBJECTIVE: To characterize OS and CSS between primary tumor (T) stages in non-metastatic bladder cancer (BC) patients. METHODS: Non-metastatic BC patients were identified in the National Cancer Database (NCDB; 2004-2015) (n = 343,163) and National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER) (n = 130,751). Cox multivariable regression compared relationships between T stage (LGTa, HGTa, Tis, LGT1, HGT1, T2-T4) and OS or CSS for all patients and sub-cohorts. RESULTS: Compared to stage LGTa as a reference, overall (SEER; NCDB) and cancer-specific (SEER) survival significantly declined with increasing T stage. Using SEER, OS ranged from HGTa (HR 1.16, CI 1.13-1.21, p < 0.001) to T4 (HR 5.70, CI 5.41-6.00, p < 0.001) with a steep inflection between HGT1 (HR 1.68, CI 1.63-1.73, p < 0.001) and T2 (HR 3.39, CI 3.30-3.49, p < 0.001), which was verified with NCDB. The association of stage and CSS was even more pronounced: HGTa (84% 10 year-CSS, HR 1.94, CI 1.81-2.08, p < 0.001), Tis (82% 10 year-CSS, HR 2.28, CI 2.09-2.47, p < 0.001), LGT1 (84% 10 year-CSS, HR 2.30, CI 2.11-2.51, p < 0.001), HGT1 (72% 10 year-CSS, HR 4.24, CI 4.01-4.47, p < 0.001), T2 (48% 10 year-CSS, HR 12.18, CI 11.57-12.82, p < 0.001), T3 (45% 10 year-CSS, HR 14.60, CI 13.63-15.64, p < 0.001), and T4 (29% 10 year-CSS, HR 22.76, CI 21.19-24.44, p < 0.001). CONCLUSIONS: Earlier T stage at diagnosis was associated with better OS largely due to differences in CSS. A clinically significant difference between Stage I and Stage II was verified herein in multiple cohorts. Therefore, earlier stage at diagnosis, specifically preventing muscle invasive BC, could potentially improve survival.
KW - Urinary bladder neoplasms
KW - early detection of cancer
KW - epidemiology
KW - neoplasm staging
KW - survival
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UR - http://www.scopus.com/inward/citedby.url?scp=85103058152&partnerID=8YFLogxK
U2 - 10.3233/BLC-200381
DO - 10.3233/BLC-200381
M3 - Article
AN - SCOPUS:85103058152
SN - 2352-3727
VL - 7
SP - 23
EP - 31
JO - Bladder Cancer
JF - Bladder Cancer
IS - 1
ER -