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Abstract：
Black individuals with muscle-invasive bladder cancer (MIBC) experienced 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed Black-White differences in survival. Yet little is known of how interactions between race/ethnicity and receipt of GBT drive within- and between-race survival differences.
Black, White, and Latino individuals diagnosed with nonmetastatic, locally advanced MIBC from 2004 to 2013 within the National Cancer Database were included. Guideline-based treatment was defined as the receipt including one or more of the following treatment modalities: radical cystectomy (RC), neoadjuvant chemotherapy with RC, RC with adjuvant chemotherapy, and/or chemoradiation based on American Urological Association guidelines. Cox proportional hazards model of mortality estimated effects of GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates.
Of the 54 910 MIBC individuals with 125 821 person-years of posttreatment observation (max = 11 years), 6.9% were Black, and 3.0% were Latino. Overall, 51.4%, 45.3%, and 48.5% of White, Black, and Latino individuals received GBT. Latino individuals had lower hazard of death compared to Black (HR 0.81, 95% CI 0.75-0.87) and White individuals (HR 0.92, 95% 0.86-0.98). With GBT, Latino and White individuals had similar outcomes (HR = 1.00, 95% 0.91-1.10) and both fared better than Black individuals (HR = 0.88, 95% 0.79-0.99 and HR = 0.88, 95% 0.83-0.94, respectively). Without GBT, Latino individuals fared better than White (HR = 0.85, 95% 0.77-0.93) and Black individuals (HR = 0.74, 95% 0.67-0.82) while White individuals fared better than Black individuals (HR = 0.87, 95% 0.83-0.92). Black individuals with GBT fared worse than Latinos without GBT (HR = 1.02, 95% 0.92-1.14), although not statistically significant.
Low GBT levels demonstrated an \"under-allocation\" of GBT to those who needed it most-Black individuals. Interventions to improve GBT allocation may mitigate race-based survival differences observed in MIBC.
Black, White, and Latino individuals diagnosed with nonmetastatic, locally advanced MIBC from 2004 to 2013 within the National Cancer Database were included. Guideline-based treatment was defined as the receipt including one or more of the following treatment modalities: radical cystectomy (RC), neoadjuvant chemotherapy with RC, RC with adjuvant chemotherapy, and/or chemoradiation based on American Urological Association guidelines. Cox proportional hazards model of mortality estimated effects of GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates.
Of the 54 910 MIBC individuals with 125 821 person-years of posttreatment observation (max = 11 years), 6.9% were Black, and 3.0% were Latino. Overall, 51.4%, 45.3%, and 48.5% of White, Black, and Latino individuals received GBT. Latino individuals had lower hazard of death compared to Black (HR 0.81, 95% CI 0.75-0.87) and White individuals (HR 0.92, 95% 0.86-0.98). With GBT, Latino and White individuals had similar outcomes (HR = 1.00, 95% 0.91-1.10) and both fared better than Black individuals (HR = 0.88, 95% 0.79-0.99 and HR = 0.88, 95% 0.83-0.94, respectively). Without GBT, Latino individuals fared better than White (HR = 0.85, 95% 0.77-0.93) and Black individuals (HR = 0.74, 95% 0.67-0.82) while White individuals fared better than Black individuals (HR = 0.87, 95% 0.83-0.92). Black individuals with GBT fared worse than Latinos without GBT (HR = 1.02, 95% 0.92-1.14), although not statistically significant.
Low GBT levels demonstrated an \"under-allocation\" of GBT to those who needed it most-Black individuals. Interventions to improve GBT allocation may mitigate race-based survival differences observed in MIBC.
摘要：
患有肌肉浸润性膀胱癌（MIBC）的黑人个体经历了21％的基于指南的治疗（GBT）的几率较低，治疗差异解释了35％的观察到的生存黑白差异。然而，鲜为人知的是，种族/族裔与GBT驱动的接收之间的相互作用与种族内部和种族之间的生存差异。
黑色,白色,和被诊断为非转移性的拉丁裔个体，纳入国家癌症数据库中2004年至2013年的局部晚期MIBC.基于指南的治疗被定义为包括以下一种或多种治疗方式的收据：根治性膀胱切除术（RC），RC新辅助化疗，RC辅助化疗，和/或根据美国泌尿外科协会指南进行放化疗。死亡率的Cox比例风险模型估计GBT状态的影响，种族/民族,以及按种族/种族划分的GBT互动，调整协变量。
在54.910MIBC个体中，治疗后观察到125.821人年（最大=11年），6.9%是黑人，拉丁美洲人占3.0%。总的来说,51.4%,45.3%,白人的48.5%，黑色,拉丁美洲人接受了GBT。与黑人（HR0.81，95％CI0.75-0.87）和白人（HR0.92，95％0.86-0.98）相比，拉丁美洲人的死亡风险较低。有了GBT,拉丁裔和白人具有相似的结果（HR=1.00，95％0.91-1.10），并且两者的表现都优于黑人（分别为HR=0.88，95％0.79-0.99和HR=0.88，95％0.83-0.94）。没有GBT,拉丁美洲人的表现优于白人（HR=0.85，95％0.77-0.93）和黑人（HR=0.74，95％0.67-0.82），而白人的表现优于黑人（HR=0.87，95％0.83-0.92）。有GBT的黑人比没有GBT的拉丁裔更差（HR=1.02，95％0.92-1.14），虽然没有统计学意义。
低GBT水平向最需要GBT的人-黑人个人-“分配不足”。改善GBT分配的干预措施可能会减轻MIBC中观察到的基于种族的生存差异。
黑色,白色,和被诊断为非转移性的拉丁裔个体，纳入国家癌症数据库中2004年至2013年的局部晚期MIBC.基于指南的治疗被定义为包括以下一种或多种治疗方式的收据：根治性膀胱切除术（RC），RC新辅助化疗，RC辅助化疗，和/或根据美国泌尿外科协会指南进行放化疗。死亡率的Cox比例风险模型估计GBT状态的影响，种族/民族,以及按种族/种族划分的GBT互动，调整协变量。
在54.910MIBC个体中，治疗后观察到125.821人年（最大=11年），6.9%是黑人，拉丁美洲人占3.0%。总的来说,51.4%,45.3%,白人的48.5%，黑色,拉丁美洲人接受了GBT。与黑人（HR0.81，95％CI0.75-0.87）和白人（HR0.92，95％0.86-0.98）相比，拉丁美洲人的死亡风险较低。有了GBT,拉丁裔和白人具有相似的结果（HR=1.00，95％0.91-1.10），并且两者的表现都优于黑人（分别为HR=0.88，95％0.79-0.99和HR=0.88，95％0.83-0.94）。没有GBT,拉丁美洲人的表现优于白人（HR=0.85，95％0.77-0.93）和黑人（HR=0.74，95％0.67-0.82），而白人的表现优于黑人（HR=0.87，95％0.83-0.92）。有GBT的黑人比没有GBT的拉丁裔更差（HR=1.02，95％0.92-1.14），虽然没有统计学意义。
低GBT水平向最需要GBT的人-黑人个人-“分配不足”。改善GBT分配的干预措施可能会减轻MIBC中观察到的基于种族的生存差异。
