Treatment Type and Mortality for Black Versus White Patients With Muscle-Invasive Bladder Cancer

Area of Science:

• Oncology
• Urologic Oncology
• Health Disparities

Background:

• Black patients with muscle-invasive bladder cancer exhibit higher mortality rates than White patients.
• Existing research indicates potential racial disparities in bladder cancer outcomes.

Purpose of the Study:

• To investigate the association between treatment modality and survival outcomes in Black versus White patients with muscle-invasive bladder cancer.
• To determine if racial differences in mortality persist after accounting for treatment type.

Main Methods:

• Retrospective analysis of 2119 patients with nonmetastatic muscle-invasive bladder cancer from the SEER-Medicare Database (2008-2017).
• Comparison of overall survival using Cox regression and bladder cancer-specific survival using Fine-Gray competing risks regression.
• Inclusion of patients treated with either cystectomy or trimodal therapy, adjusting for age, sex, tumor stage, and comorbidity score.

Main Results:

• No significant difference in all-cause mortality was observed between Black and White patients after adjusting for treatment and covariates.
• Black patients who underwent cystectomy had a significantly higher hazard of bladder cancer-specific death compared to White patients (P < .01).
• This disparity in cancer-specific survival was not evident in patients treated with trimodal therapy.

Conclusions:

• Treatment type significantly influences bladder cancer-specific survival disparities between Black and White patients.
• Cystectomy is associated with a higher risk of bladder cancer-specific death for Black patients compared to White patients.
• Trimodal therapy may mitigate racial disparities in bladder cancer-specific survival.