Abstract
442 Background: There is conflicting evidence regarding MIBC treatment and outcomes. Our aim was to assess the variation in four quality metrics (neoadjuvant chemotherapy, time to treatment ≤ 3 months, ≥ 10 lymph nodes removed, use of continent urinary diversion) according to race. Methods: Using the National Cancer Database (NCDB), we identified 17,944 MIBC patients undergoing radical cystectomy. Race was stratified into non-Hispanic White (nHW), African-American (AA), Asian (A) and Hispanic/Latino (H). Uni- and multivariable analyzes examined the association between race and receipt of quality metrics, accounting for baseline characteristics. Cox regression model was used to calculate differences in overall survival(OS). Results: Baseline characteristics (insurance status, income, education, age, sex, facility type, Charlston Comorbidity Index) were significantly different between races. We did not observe any difference in the number of quality metrics received ( ≤ 1 vs ≥ 2) according to race (p = 0.161). However, there were significant differences for time to treatment and diversion type (p = 0.002, 0.012). Blacks had a significantly worse OS after adjustment for significant confounders (OR: 1.224, CI: 1.113-1.347). Conclusions: Even after accounting for treatment disparities, AA have a worse OS, warranting further investigation into potential biologic and epidemiologic factors affecting race and MIBC.
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