Years of Life Lost in Patients with Muscle-Invasive and Metastatic Bladder Cancer

Muscle-invasive and metastatic urothelial carcinoma of urinary bladder (UCUB) is associated with poor overall survival. However, individual years of life lost (YLL) according to detailed patient and disease characteristics have never been quantified.

Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021), muscle-invasive organ-confined (OC, T2N0M0), non-organ-confined (NOC, T3-4 and/or N1-3 M0), and metastatic (anyT, anyN, M1) UCUB patients aged 40-75 years were included. Relying on Social Security Administration (SSA) life tables, a 1:1 age, sex, and year of diagnosis matched control (Monte Carlo simulation) was simulated for each patient. Kaplan-Meier method was used to calculate average YLL truncated at the age of 75 years between SEER cases and SSA simulated controls.

A total of 30,519 patients were included: 14,754 (48.3%) OC, 10,330 (33.8%) NOC, and 5435 (17.8%) metastatic. Compared with simulated population controls, average YLL was 3.7, 6.0, and 9.1 years for OC, NOC, and metastatic disease, respectively. YLL was most pronounced among patients diagnosed at younger ages (40-55 years: 9.2, 14.1, and 18.0 years for OC, NOC, and metastatic, respectively), decreasing with advancing age at diagnosis. Less pronounced YLL observations were recorded in most contemporary years (2017-2021: 2.7, 4.4, and 7.9 years for OC, NOC, and metastatic, respectively) across all stages compared with earlier periods. No clinically meaningful differences in YLL were observed between sexes. (male OC: 3.6, NOC: 5.9, metastatic: 9.0; female OC: 4.1, NOC: 6.6, metastatic: 9.5).

UCUB is associated with substantial YLL, particularly in metastatic and younger patients. However, an YLL decrease over time was observed.