1749 IMPROVED SURVIVAL INSPITE OF NO DECREASE IN THE INCIDENCE OF LYMPH NODE INVASION IN WOMEN RECEIVING SURGERY FOR BLADDER CANCER: TIME-DEPENDENT TRENDS

Abstract

INTRODUCTION AND OBJECTIVES: The incidence of bladder cancer (BC) is lower in females than in males, but females lose a greater fraction of their life expectancy to this disease than males do. We examined stage migration and changes in cancer specific mortality (CSM) in females receiving surgery for BC over a period of 20 years. METHODS: Female patients diagnosed with BC between 1988 and 2008 were isolated from the Surveillance, Epidemiology and End Results (SEER) database. The analysis was limited to patients receiving surgery for transitional cell carcinoma. Logistic regression analysis was used to measure the time dependant changes of the odds of diagnosis with muscle-invasive bladder cancer (MIBC), the odds of lymph nodes involvement (LNI), and the odds of CSM due to MIBC, controlling for the confounders of age, race, SEER registry, marital status, and income. RESULTS: 47,628 female patients were included in the study, with 11,788 patients diagnosed with MIBC. The median age was 71.5 years (SD 12.6), and most were white (89.2%) and married (40.2%). Overall median survival for MIBC was 37.9 months, which decreased to 23.8 months if lymph nodes were involved. The odds of having MIBC significantly decreased (odds of diagnosis with MIBC in 2008 compared to 1988 is 0.492; 95% CI: 0.419-0.579), with no significant change in the odds of LNI (odds of diagnosis with LNI in 2008 compared to 1988 is 1.271; 95% CI: 0.791-2.041). The odds of CSM due to MIBC significantly decreased in the more recent decade compared to the earlier one (The odds of dying because of MIBC in 1999-2008 compared to 1988-1998 is 0.475; 95% CI: 0.495-0.527). CONCLUSIONS: Female BC patients are diagnosed at an earlier stage of the disease and are less likely to die of MIBC in the last 10 years. There is no decrease in the incidence of lymph node-positive disease, but this has not resulted in increased CSM. The more extensive lymph node dissection in recent years may have contributed to the stable incidence of LNI and improved disease outcome. Source of Funding: None