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The natural history...
The natural history of untreated muscle-invasive bladder cancer
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Martini, A. (författare)
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Sfakianos, J. P. (författare)
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- Renstrom-Koskela, L. (författare)
- Karolinska Institutet
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Mortezavi, A. (författare)
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Falagario, U. G. (författare)
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- Egevad, L. (författare)
- Karolinska Institutet
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Hosseini, A. (författare)
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Mehrazin, R. (författare)
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Galsky, M. D. (författare)
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- Steineck, Gunnar, 1952 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences
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- Wiklund, N. P. (författare)
- Karolinska Institutet
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(creator_code:org_t)
- 2019-08-07
- 2020
- Engelska.
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Ingår i: Bju International. - : Wiley. - 1464-4096 .- 1464-410X. ; 125:2, s. 270-275
- Relaterad länk:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Objective To describe the natural history of untreated muscle-invasive bladder cancer (MIBC) and compare the oncological outcomes of treated and untreated patients. Patients and Methods We utilised a database encompassing all patients with newly diagnosed bladder cancer in Stockholm, Sweden between 1995 and 1996. The median follow-up for survivors was 14.4 years. Overall, 538 patients were diagnosed with bladder cancer of whom 126 had clinically localised MIBC. Patients were divided into two groups: those who received radical cystectomy or radiation therapy, and those who did not receive any form of treatment. Multivariable Cox or competing-risks regressions were adopted to predict metastasis, overall survival (OS), and cancer-specific mortality (CSM), when appropriate. Analyses were adjusted for age at diagnosis, sex, tumour stage, clinical N stage, and treatment. Results In all, 64 (51%) patients did not receive any definitive local treatment. In the untreated group, the median (interquartile range) age at diagnosis was 79 (63-83) vs 69 (63-74) years in the treated group (P < 0.001). Overall, 109 patients died during follow-up. At 6 months after diagnosis, 38% of the untreated patients had developed metastatic disease and 41% had CSM. The 5-year OS rate for untreated and treated patients was 5% (95% confidence interval [CI] 1, 12%) vs 48% (95% CI 36, 60%), respectively. Patients not receiving any treatment had a 5-year cumulative incidence of CSM of 86% (95% CI 75, 94%) vs 48% (95% CI 36, 60%) for treated patients. Untreated patients had a higher risk of progression to metastatic disease (hazard ratio [HR] 2.40, 95% CI 1.28, 4.51; P = 0.006), death from any cause (HR 2.63, 95% CI 1.65, 4.19; P < 0.001) and CSM (subdistribution HR 2.02, 95% CI 1.24, 3.30; P = 0.004). Conclusions Untreated patients with MIBC are at very high risk of near-term CSM. These findings may help balance the risks vs benefits of integrating curative intent therapy particularly in older patients with MIBC.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Nyckelord
- urothelial cancer
- metastasis
- overall survival
- #blcsm
- #BladderCancer
- complications
- cystectomy
- quality
- Urology & Nephrology
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Martini, A.
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Sfakianos, J. P.
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Renstrom-Koskela ...
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Mortezavi, A.
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Falagario, U. G.
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Egevad, L.
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visa fler...
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Hosseini, A.
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Mehrazin, R.
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Galsky, M. D.
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Steineck, Gunnar ...
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Wiklund, N. P.
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visa färre...
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Cancer och onkol ...
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- Av lärosätet
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Göteborgs universitet
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Karolinska Institutet