Patterns of care and associated social determinants of health in the definitive treatment of localized muscle-invasive bladder cancer patients.

IF 1.2 4区医学 Q4 ONCOLOGY

Bladder Cancer Pub Date : 2026-04-13 eCollection Date: 2026-04-01 DOI:10.1177/23523735261438727

Megan Mai, Vivie Tran, Albert Zhu, Duke Appiah, Zheng Shi

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引用次数: 0

Abstract

Background: Neoadjuvant chemotherapy followed by radical cystectomy (NACT-RC) is the prevailing standard of care for muscle-invasive bladder cancer (MIBC), but trimodality treatment (TMT) using chemoradiation after transurethral resection of bladder tumor (TURBT) is an effective alternative in select patients.

Objective: This study examined patterns of care and impact of social determinants of health on the overall survival (OS) using the National Cancer Database (NCDB).

Methods: Data on patients aged ≥18 years with stage II-IIIA MIBC treated with TMT or NACT-RC during 2014-2021 were analyzed with propensity score matching. Logistic and Cox regression were used to evaluate the association of social determinants of health with patterns of care and OS.

Results: Among 18,072 cases (mean age 68.3 years), 77.1% received NACT-RC. TMT use increased from 18.4% in 2014 to 27.1% in 2021 (p < 0.001). The odds for receiving NACT-RC were higher for patients with stage IIIA (odds ratio (OR) = 1.21, 95% confidence interval (CI) 1.09-1.34). However, older patients (OR 0.86, 95% CI 0.87-0.88), those treated at comprehensive community cancer programs (OR 0.51, 95% CI: 0.46-0.55), or used Medicaid (OR = 0.48, 95% CI 0.39-0.61) had lower odds for receiving NACT-RC. In propensity score matching analysis, NACT-RC was associated with lower mortality compared to TMT (Hazard ratio (HR) = 0.66, 95% CI:0.59-0.73). Medicaid users receiving NACT-RC had the highest mortality risk (HR = 1.47, 95% CI:1.28-1.68, p_interaction=0.001).

Conclusion: TMT for MIBC has increased in recent years. Selection between NACT-RC and TMT was influenced by age, stage, diagnosis year, comorbidities, travel distance, facility, and insurance type, highlighting disparities in MIBC treatment.

Categories: Radiation Oncology, Oncology.

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局部肌肉浸润性膀胱癌患者最终治疗中的护理模式和相关的健康社会决定因素

背景：新辅助化疗加根治性膀胱切除术（NACT-RC）是肌肉浸润性膀胱癌（MIBC）的主流治疗标准，但经尿道膀胱肿瘤切除术（TURBT）后的放化疗三段式治疗（TMT）在特定患者中是一种有效的选择。目的：本研究使用国家癌症数据库（NCDB）检查护理模式和健康的社会决定因素对总生存（OS）的影响。方法：对2014-2021年期间接受TMT或NACT-RC治疗的年龄≥18岁II-IIIA期MIBC患者的数据进行倾向评分匹配分析。采用Logistic回归和Cox回归来评估健康的社会决定因素与护理模式和生存状况之间的关系。结果：18072例患者（平均年龄68.3岁）中77.1%接受了NACT-RC治疗。TMT的使用从2014年的18.4%增加到2021年的27.1% （p交互作用=0.001）。结论：近年来MIBC的TMT有所增加。NACT-RC和TMT的选择受年龄、分期、诊断年份、合并症、出行距离、设施和保险类型的影响，突出了MIBC治疗的差异。分类：放射肿瘤学，肿瘤学。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bladder Cancer Medicine-Urology

CiteScore

1.60

自引率

0.00%

发文量

期刊介绍： Bladder Cancer is an international multidisciplinary journal to facilitate progress in understanding the epidemiology/etiology, genetics, molecular correlates, pathogenesis, pharmacology, ethics, patient advocacy and survivorship, diagnosis and treatment of tumors of the bladder and upper urinary tract. The journal publishes research reports, reviews, short communications, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that expedites our fundamental understanding and improves treatment of tumors of the bladder and upper urinary tract.