title: Muscle-invasive bladder cancer: evaluating treatment and survival in the National Cancer Data Base.
abstract: OBJECTIVE
  To evaluate the association between patterns of care and patient survival for the treatment of muscle-invasive bladder cancer (MIBC) using a large, national database.
  
  
  METHODS
  We identified a cohort of 36,469 patients with MIBC (stage II) from 1998 to 2010 from the National Cancer Data Base. Patients were stratified into four treatment groups: radical cystectomy, chemo-radiation, other therapy, or no treatment. Overall survival (OS) among the groups was evaluated using Kaplan-Meier analysis and the log rank test. A multivariable Cox proportional hazards model was fit to evaluate the association between treatment groups and OS.
  
  
  RESULTS
  In all, 27% of patients received radical cystectomy, 10% chemo-radiation, 61% other therapy and 2% no treatment. Unadjusted Kaplan-Meier analysis showed significant differences by treatment group, with cystectomy having the greatest median OS (48 months) followed by chemo-radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, the OS for cystectomy was similar to that for chemo-radiation (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.98, 1.12), but superior to other therapy (HR 1.42; 95% CI 1.35, 1.48), and no treatment (HR 2.40; 95% CI 2.12, 2.72). The OS time for chemo-radiation was superior to other therapy and no treatment.
  
  
  CONCLUSIONS
  Radical cystectomy and chemo-radiation are significantly underused despite a substantial survival benefit compared with other therapies or no treatment. Future studies are needed to optimise care delivery and improve outcomes for patients with MIBC.
authors: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC, USA.
authors: Angela B
authors: AB
authors: Smith
authors: Allison M
authors: AM
authors: Deal
authors: Michael E
authors: ME
authors: Woods
authors: Eric M
authors: EM
authors: Wallen
authors: Raj S
authors: RS
authors: Pruthi
authors: Ronald C
authors: RC
authors: Chen
authors: Matthew I
authors: MI
authors: Milowsky
authors: Matthew E
authors: ME
authors: Nielsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods / Q000401:mortality; D012042:Registries; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*
keywords: bladder cancer; bladder-sparing therapy; radical cystectomy; treatment outcome; urinary bladder neoplasms