Sex and Racial Disparities in the Treatment and Outcomes of Muscle-Invasive Bladder Cancer

Bladder Cancer

Urology. 2020 Aug 15:S0090-4295(20)30992-4. doi: 10.1016/j.urology.2020.06.087. Online ahead of print.


OBJECTIVE: To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database.

METHODS: Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004-2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality.

RESULTS: 47229 patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs. men (13.0% vs. 11.6%, p=0.009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (OR 1.01, 95% CI 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, p<0.001) and black (OR 1.29, CI 1.11-1.50, p=0.001) patients. Females had a lower overall survival on Cox regression analysis (HR 0.92, 95% CI 0.87-0.97) CONCLUSIONS: While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment.