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

Black patients with muscle-invasive bladder cancer have higher mortality compared with White patients. This study evaluated the association of treatment type on overall and bladder cancer-specific survival across these racial groups.

We identified patients diagnosed with nonmetastatic urothelial muscle-invasive bladder cancer from 2008 to 2017 using the Surveillance, Epidemiology and End Results (SEER)-Medicare Database. Black and White patients treated with cystectomy or trimodal therapy were included. Cox proportional hazards regression was used to examine the association of race and treatment type on overall survival, adjusting for tumor stage, age at diagnosis, sex, and comorbidity score. Fine-Gray competing risks regression was used to examine bladder cancer-specific survival with adjustment for the same covariates.

Among 2119 patients, race was not significantly associated with all-cause mortality after adjusting for treatment type (ie, cystectomy or trimodal therapy), sex, age at diagnosis, and comorbidity score (P = .12). However, among patients who underwent cystectomy, Black patients had a significantly higher hazard of bladder cancer-specific death compared with White patients (P < .01). This difference in cancer-specific survival was not observed in patients who underwent trimodal therapy.

Black patients treated with cystectomy, but not trimodal therapy, have a higher hazard of bladder cancer-specific death, even after adjusting for patient factors and tumor stage. This difference was not observed for overall survival.