title: Survival after radical cystectomy of non-bilharzial squamous cell carcinoma vs urothelial carcinoma: a competing-risks analysis.
abstract: OBJECTIVE
  •  To test the effect of histological subtype (NBSCC vs UC) on cancer-specific mortality (CSM), after adjusting for other-cause mortality (OCM). •  In Western countries, non-bilharzial squamous cell carcinoma (NBSCC) is the second most common histological subtype in bladder cancer (BCa) after urothelial carcinoma (UC).
  
  
  METHODS
  •  We identified 12,311 patients who were treated with radical cystectomy (RC) between 1988 and 2006, within 17 Surveillance, Epidemiology and End Results (SEER) registries. •  Univariable and multivariable competing-risks analyses tested the relationship between histological subtype and CSM, after accounting for OCM. •  Covariates consisted of age, sex, year of surgery, race, pathological T and N stages, as well as tumour grade.
  
  
  RESULTS
  •  Histological subtype was NBSCC in 614 (5%) patients vs UC in 11,697 (95%) patients. •  At RC, the rate of non-organ confined (NOC) BCa was higher in NBSCC patients than in their UC counterparts (71.7% vs 52.2%; P < 0.001). •  After adjustment for OCM, The 5-year cumulative CSM rates were 25.0% vs 19.8% (P= 0.2) for patients with NBSCC vs UC organ confined (OC) BCa, respectively. The same rates were 46.3% vs 49.3% in patients with NOC BCa (P= 0.1). •  In multivariable competing-risks analyses, histological subtype (NBSCC vs UC) failed to achieve independent predictor status of CSM in patients with OC (hazard ratio, 1.2; P= 0.06) or NOC BCa (hazard ratio, 1.1; P= 0.1).
  
  
  CONCLUSIONS
  •  At RC, the rate of NOC BCa is higher in NBSCC patients than in their UC counterparts. •  Despite a more advanced stage at surgery, NBSCC histological subtype is not associated with a less favourable CSM than UC histological subtype, after accounting for OCM and the extent of the disease (OC vs NOC).
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montreal Health Centre, Montreal, Canada. firas.abdollah@gmail.com
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Jan
authors.initials: J
authors.lastname: Schmitges
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Orchidee
authors.initials: O
authors.lastname: Djahangirian
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery