Abstract

BACKGROUND:

There is insufficient data to recommend screening for bladder cancer (BC). For future BC screening trials, it is important to understand how and if tumor (T) stage can act as a surrogate outcome marker for overall (OS) and cancer-specific (CSS) survival.

OBJECTIVE:

To characterize OS and CSS between primary tumor (T) stages in non-metastatic bladder cancer (BC) patients.

METHODS:

Non-metastatic BC patients were identified in the National Cancer Database (NCDB; 2004-2015) (n = 343,163) and National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER) (n = 130,751). Cox multivariable regression compared relationships between T stage (LGTa, HGTa, Tis, LGT1, HGT1, T2-T4) and OS or CSS for all patients and sub-cohorts.

RESULTS:

Compared to stage LGTa as a reference, overall (SEER; NCDB) and cancer-specific (SEER) survival significantly declined with increasing T stage. Using SEER, OS ranged from HGTa (HR 1.16, CI 1.13– 1.21, p < 0.001) to T4 (HR 5.70, CI 5.41– 6.00, p < 0.001) with a steep inflection between HGT1 (HR 1.68, CI 1.63– 1.73, p < 0.001) and T2 (HR 3.39, CI 3.30– 3.49, p < 0.001), which was verified with NCDB. The association of stage and CSS was even more pronounced: HGTa (84% 10 year-CSS, HR 1.94, CI 1.81– 2.08, p < 0.001), Tis (82% 10 year-CSS, HR 2.28, CI 2.09– 2.47, p < 0.001), LGT1 (84% 10 year-CSS, HR 2.30, CI 2.11– 2.51, p < 0.001), HGT1 (72% 10 year-CSS, HR 4.24, CI 4.01– 4.47, p < 0.001), T2 (48% 10 year-CSS, HR 12.18, CI 11.57– 12.82, p < 0.001), T3 (45% 10 year-CSS, HR 14.60, CI 13.63– 15.64, p < 0.001), and T4 (29% 10 year-CSS, HR 22.76, CI 21.19– 24.44, p < 0.001).

CONCLUSIONS:

Earlier T stage at diagnosis is associated with better OS largely due to differences in CSS. A clinically significant difference between Stage I and Stage II is verified herein in multiple cohorts. Therefore, earlier stage at diagnosis, specifically preventing muscle invasive BC, could potentially improve survival.

中文翻译：

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T期生存率的局限性膀胱癌患者：未来筛选试验的意义。

摘要

背景：

没有足够的数据推荐筛查膀胱癌（BC）。对于将来的BC筛查试验，重要的是了解肿瘤（T）分期如何以及是否可以作为总体（OS）和癌症特异性（CSS）生存的替代结果标记。

目的：

在非转移性膀胱癌（BC）患者中表征原发性肿瘤（T）期之间的OS和CSS。

方法：

在国家癌症数据库（NCDB; 2004-2015）（n = 343,163）和国家癌症研究所监视，流行病学和最终结果数据库（SEER）（n = 130,751）中确定了非转移性BC患者。Cox多变量回归比较了所有患者和亚人群的T期（LGTa，HGTa，Tis，LGT1，HGT1，T2-T4）与OS或CSS之间的关系。

结果：

与LGTa期作为参考相比，总体（SEER; NCDB）和癌症特异性（SEER）生存率随着T期的增加而显着下降。使用SEER，OS范围从HGTa（HR 1.16，CI 1.13–1.21，p  <0.001）到T4（HR 5.70，CI 5.41–6.00，p  <0.001），而HGT1（HR 1.68，CI 1.63-1.73，p  <0.001）和T2（HR 3.39，CI 3.30–3.49，p  <0.001），已通过NCDB验证。阶段与CSS的关联更加明显：HGTa（10年CSS的84％，HR 1.94，CI 1.81-2.08，p  <0.001），Tis（10年CSS的82％，HR 2.28，CI 2.09-2.47，p  <0.001），LGT1（10％CSS十年，HR 2.30，CI 2.11–2.51，p <0.001），HGT1（72％10年CSS，HR 4.24，CI 4.01-4.47，p  <0.001），T2（48％10年CSS，HR 12.18，CI 11.57-12.82，p  <0.001），T3（ 10％CSS的45％，HR 14.60，CI 13.63-15.64，p  <0.001）和T4（10％CSS的10年，HR 22.76，CI 21.19-24.44，p  <0.001）。

结论：

诊断的早期T期与更好的OS相关，这主要是由于CSS的差异。本文在多个队列中证实了I期和II期之间的临床显着差异。因此，在诊断的早期阶段，特别是预防肌肉浸润性BC，可能会改善生存率。