title: Effect of African-American Race on Tumor Recurrence After Radical Cystectomy for Urothelial Carcinoma of the Bladder.
abstract: BACKGROUND
  African-American race appears to be associated with higher stages of urothelial carcinoma of the bladder (UCB) at presentation and poorer survival. However, the independent effect of African-American race on objective tumor recurrence after radical cystectomy (RC) after controlling for clinical and pathologic variables is unknown.
  
  
  METHODS
  The data from consecutive patients with UCB who underwent RC with curative intent at a single institution (University of Alabama, Birmingham) from 2001 to 2012 with or without perioperative chemotherapy or chemoradiation were reviewed. The patient demographics, risk factors, clinical course, pathologic characteristics, and long-term outcomes were collected. Descriptive statistics were performed. Cox regression analysis was performed for key clinical, demographic, and pathologic variables, including race, stratified as African American versus white.
  
  
  RESULTS
  A total of 215 patients, 163 men (76%) and 52 women (24%), with a mean age at RC of 65.6 years, were identified and reviewed. A total of 186 patients (87%) were white and 28 (13%) were African American. The median follow-up period after RC was 17.6 months. On conventional multivariate analysis, African-American race nearly attained statistical significance (hazard ratio [HR], 2.48; 95% confidence interval [CI], 0.98-6.29; P = .055). In a stepwise regression model, race was significantly associated with tumor recurrence (HR, 3.11; 95% CI, 1.2-7.4; P < .011).
  
  
  CONCLUSIONS
  African-American race appears to be independently associated with a greater risk of tumor recurrence after RC for UCB. The effect of host genetics on tumor biology needs to be characterized at the genomic level to develop precision medicine.
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Ravi K
authors: RK
authors: Paluri
authors: Department of Biostatistics, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Charity J
authors: CJ
authors: Morgan
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: David J
authors: DJ
authors: Mooney
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Okechukwu
authors: O
authors: Mgbemena
authors: Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Eddy S
authors: ES
authors: Yang
authors: Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Shi
authors: S
authors: Wei
authors: Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Erik
authors: E
authors: Kouba
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Gurudatta
authors: G
authors: Naik
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Nemer R
authors: NR
authors: El Mouallem
authors: Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Tyler
authors: T
authors: Poston
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Benjamin
authors: B
authors: Jones
authors: Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Jeffrey
authors: J
authors: Nix
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Graeme B
authors: GB
authors: Bolger
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Mollie
authors: M
authors: Deshazo
authors: Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Division of Hematology Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL. Electronic address: gsonpavde@uabmc.edu.
authors: Guru
authors: G
authors: Sonpavde
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000208:ethnology; D001749:Urinary Bladder Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000601:surgery*
keywords: African-American; Bladder cancer; Prognosis; Radical cystectomy; Recurrence