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.
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。