82 96
Bladder
Cancer
A
Comparative
Analysis
of
the
Influence
of
Gender,
Pathway
Delays,
and Risk
Factor
Exposures
on
the
Long-term Outcomes
of
Bladder
Cancer
Richard
T.
Bryan
a ,z
,
Tim
Evans
b , z,
Janet
A. Dunn
c ,Gulnaz
Iqbal
c ,Sarah
Bathers
d ,Stuart
I.
Collins
a ,y
, Nicholas D.
James
e ,James W.F.
Catto
f , * ,D. Michael
A. Wallace
ga
School
of Cancer
Sciences, University
of Birmingham,
Birmingham, UK;
b
Public Health
England,
Birmingham, UK;
c
Warwick
Clinical
Trials Unit, University
of Warwick,
Coventry, UK;
d
Primary
Care Clinical Research
and
Trials Unit, University
of Birmingham, Birmingham, UK;
e
Cancer Research Unit, University
of
Warwick, Coventry, UK;
f
Department of Oncology, University of
Sheffield,
Sheffield, UK;
g
School of
Surgery, University of Western Australia, Crawley, Australia
E U R O P E A N U R O L O G Y F O C U S 1 ( 2 0 1 5 ) 8 2 – 8 9available
at
www.sciencedirect.comjournal
homepage:
www.europeanurology.comArticle
info
Article
history:
Accepted
January
7,
2015
Associate
Editor:
Gianluca Giannarini
Keywords:
Urinary
bladder
neoplasms
Delayed
diagnosis
Sex
factors
Long-term
effects
Treatment
outcome
Risk
factors
Abstract
Background:
The
relationship
between
pathway
delays
and
bladder
cancer–specific
survival
is
complex
because
of
the
influence
of
tumour-
and patient-specific
factors.
Objective:
To
investigate
the
influence
of
tumour
factors,
patient
factors,
carcinogen
exposure,
and
pathway
delays
on
the
long-term
outcome
of
urothelial
bladder
cancer
(UBC).
Design,
setting, and participants:
A
cohort of 1537 UBC patients were enrolled between
January 1, 1991 and
June 30, 1992 and
followed up
for 17.7 yr. The period
from
the onset
of
symptoms
to first
treatment
(transurethral
resection of bladder
tumour, TURBT) was
divided
into
three
components
of
potential
delay.
Outcome measurements
and
statistical
analysis:
Associations
between patient
factors,
tumour
factors, and delay
times were analysed using
the Pearson
x
2
test and
the Mann-
Whitney
U
test.
Survival was
calculated
from date
of
TURBT
to date
of
death
or
censor
date
(December 31, 2010). Competing
risks of death were assessed with
the cumulative
incidence
function
(CIF);
CIF
comparisons were
performed
using
the Gray
test.
Results
and
limitations:
At
censor,
reliable
data were
available
for
1478
patients,
of
whom 75% had died. Females presented more
commonly with muscle-invasive bladder
cancer
(MIBC;
30%
vs
26%)
and
less
frequently with
pT1 disease
(18%
vs
24%;
p
= 0.06)
and had a
longer
total delay
time
(median 120 d vs 106 d,
p
= 0.02), and
those with MIBC
had a significantly higher cumulative
incidence of death due
to UBC
(80% vs 67% at 17 yr;
p
<
0.02).
Cox
regression
identified
age,
smoking
status,
and
tumour
stage,
grade,
and
size
as
the most
significant
determinants
of
poor
outcome. We
did
not
capture
down-
stream
delays
associated with
cystectomy
or
radiotherapy.
Conclusions:
Female UBC
patients
present
later
than males,
and
our
data
suggest
that
delay
in
referral
may
be
contributory.
The
relationship
between
gender,
outcomes,
delays,
and UBC
aetiology
is
complex.
Patient
summary:
We
followed
a
large
group
of bladder
cancer patients
for more
than
17
yr.
The
relationship
between
pathway
delays
and
survival
is
complex.
However,
female
patients
present
later
than male
patients,
and
our
data
suggest
that
delay
in
referral
from
general
practice may
be
contributory.
#
2015 European Association of Urology. Published by Elsevier B.V. All
rights
reserved.
y
Deceased.
z
These
authors
contributed
equally.
* Corresponding
author.
Department
of
Oncology,
The Medical
School,
Beech
Hill
Road,
Sheffield
S10
2RX, UK.
Tel.
+44
114
2712163;
Fax:
+44
114
2712268.
address:
j.catto@sheffiled.ac.uk(J.W.F.
Catto).
http://dx.doi.org/10.1016/j.euf. 2015.01.0012405-4569/
#
2015
European
Association
of Urology.
Published
by
Elsevier
B.V.
All
rights
reserved.