title: Conditional Survival in de novo Metastatic Urothelial Carcinoma.
abstract: BACKGROUND
  Second-line therapy is frequently utilized for metastatic urothelial carcinoma, but there are limited data to guide this approach. While an assessment of overall survival based on registry data may not capture the impact of second- and third-line therapies on clinical outcome, this may be reflected in relative conditional survival (RCS).
  
  
  METHODS
  Patients with stage IV urothelial carcinoma diagnosed from 1990-2010 were identified from the Surveillance, Epidemiology and End Results (SEER) dataset. The association of clinicopathologic variables with disease specific survival (DSS) was explored through univariate and multivariate analyses. DSS in subgroups divided by time period (1990-2000 v 2001-2010) was compared using the Kaplan-Meier method and log-rank test. One-year RCS at annual landmarks up to 5 years was compared in subgroups divided by time period.
  
  
  RESULTS
  Of 261,987 patients diagnosed with urothelial carcinoma from 1990-2010, 3,110 patients met criteria for the current analysis. Characteristics of patients diagnosed between 1990 and 2000 (n = 810) and 2001 to 2010 (n = 2,300) were similar and there was no significant difference in DSS between the two groups. On multivariate analysis, older age (age ≥ 80) was associated with shorter DSS (HR 1.79, 95%CI 1.48-2.15), but no association was found between time period of diagnosis and outcome. One-year RCS improved substantially through successive annual landmarks up to 5 years, but no differences were seen in subgroups divided by time of diagnosis.
  
  
  CONCLUSIONS
  No difference in RCS was observed amongst patients with stage IV urothelial carcinoma diagnosed from 1990-2000 and 2001-2010. A lack of difference in RCS (more so than cumulative DSS) may reflect a lack of progress in salvage therapies for the disease.
authors: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Sumanta Kumar
authors: SK
authors: Pal
authors: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Yulan Ingrid
authors: YI
authors: Lin
authors: Division of Urology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Bertram
authors: B
authors: Yuh
authors: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Kara
authors: K
authors: DeWalt
authors: Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Austin
authors: A
authors: Kazarian
authors: US Oncology Research, Comprehensive Cancer Centers, Las Vegas, Nevada, United States of America.
authors: Nicholas
authors: N
authors: Vogelzang
authors: Division of Biostatistics, Department of Information Science, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America.
authors: Rebecca A
authors: RA
authors: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D011379:Prognosis; D018426:SEER Program; D016879:Salvage Therapy; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D055815:Young Adult