title: Curative therapy for bladder cancer in routine clinical practice: a population-based outcomes study.
abstract: OBJECTIVE
  Definitive therapy of bladder cancer involves cystectomy or radiotherapy; controversy exists regarding optimal management. Here we describe the management and outcomes of patients treated in routine practice.
  
  
  METHODS
  Treatment records were linked to the Ontario Cancer Registry to identify all cases of bladder cancer in Ontario treated with cystectomy or radiotherapy in 1994-2008. Practice patterns are described in three study periods: 1994-1998, 1999-2003, 2004-2008. Logistic regression, Cox model and propensity score analyses were used to evaluate factors associated with treatment choice and survival.
  
  
  RESULTS
  In total, 3879 cases (74%) underwent cystectomy and 1380 (26%) were treated with primary radiotherapy. Cystectomy use increased over time (66, 75, 78%), whereas radiotherapy decreased (34, 25, 22%), P < 0.001. There was substantial regional variation in the proportion of cases undergoing radiotherapy (range 16-51%). Five year cancer-specific survival (CSS) and overall survival were 40 and 36% for surgical cases and 35 and 26% for radiotherapy cases (P < 0.001). In multivariate Cox model and propensity score analyses, there was no significant difference in CSS between surgery and radiotherapy (hazard ratio 0.99, 95% confidence interval 0.91-1.08); radiotherapy was associated with slightly inferior overall survival (hazard ratio 1.08, 95% confidence interval 1.00-1.16).
  
  
  CONCLUSIONS
  Utilisation of cystectomy for bladder cancer in routine practice has increased over time with no evidence of a significant difference in CSS between radiotherapy and cystectomy.
authors: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada. Electronic address: boothc@kgh.kari.net.
authors: C M
authors: CM
authors: Booth
authors: Department of Oncology, Queen's University, Kingston, Canada; Department of Urology, Queen's University, Kingston, Canada.
authors: D R
authors: DR
authors: Siemens
authors: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada.
authors: G
authors: G
authors: Li
authors: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada.
authors: Y
authors: Y
authors: Peng
authors: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada.
authors: W
authors: W
authors: Kong
authors: Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada.
authors: D M
authors: DM
authors: Berman
authors: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada.
authors: W J
authors: WJ
authors: Mackillop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000628:therapy*; D055815:Young Adult
keywords: Bladder cancer; cystectomy; health services; outcomes; quality of care; radiation