000			03828nam a22006377a 4500
008			200902s20202020 xxu||||| |||| 00| 0 eng d
022			_a0090-4295
024			_a10.1016/j.urology.2020.06.087 [doi]
024			_aS0090-4295(20)30992-4 [pii]
040			_aOvid MEDLINE(R)
099			_a32810481
245			_aSex and Racial Disparities in the Treatment and Outcomes of Muscle-invasive Bladder Cancer.
251			_aUrology. 151:154-162, 2021 05.
252			_aUrology. 151:154-162, 2021 05.
252			_zUrology. 2020 Aug 15
253			_aUrology
260			_c2021
260			_fFY2021
265			_saheadofprint
265			_sppublish
266			_d2020-09-02
268			_aUrology. 2020 Aug 15
269			_fFY2021
520			_aMETHODS: Using the National Cancer Database, we identified patients with muscle invasive bladder cancer from 2004-2014. Treatments analyzed included no treatment, cystectomy, neoadjuvant chemotherapy plus cystectomy ("optimal treatment"), cystectomy plus adjuvant chemotherapy, and chemoradiation. Propensity matching compared mortality outcomes between sexes. Logistic models evaluated predictors of receiving optimal treatment, as well as mortality.
520			_aOBJECTIVE: To identify racial and sex disparities in the treatment and outcomes of muscle-invasive bladder cancer (MIBC) using a nationwide oncology outcomes database.
520			_aRESULTS: 47229 patients were identified. Most patients were male (73.4%) and underwent cystectomy alone (69.0%). Propensity score matching demonstrated increased 90-day mortality in women vs. men (13.0% vs. 11.6%, p=0.009), despite adjusting for differences in treatments between sexes. Logistic regression models showed no difference in receipt of optimal treatment between sexes (OR 1.01, 95% CI 0.83-1.22) although black patients were less likely to receive optimal treatment (OR 0.15, 95% CI 0.05-0.48). Logistic regression models confirmed increased 90-day mortality in female (OR 1.17, CI 1.08-1.27, p<0.001) and black (OR 1.29, CI 1.11-1.50, p=0.001) patients. Females had a lower overall survival on Cox regression analysis (HR 0.92, 95% CI 0.87-0.97) CONCLUSIONS: While there do not appear to be significant treatment disparities between sexes, women experience higher 90-day mortality and lower overall survival. Black patients are less likely to receive optimal treatment and have a higher risk of 90-day mortality. Additional research is needed to determine the variables leading to worse outcomes in females and identify impediments to black patients receiving optimal treatment. Copyright (c) 2020. Published by Elsevier Inc.
546			_aEnglish
650			_a*Healthcare Disparities
650			_a*Urinary Bladder Neoplasms/mo [Mortality]
650			_a*Urinary Bladder Neoplasms/th [Therapy]
650			_aAged
650			_aDatabases, Factual
650			_aFemale
650			_aHumans
650			_aMale
650			_aNeoplasm Invasiveness
650			_aRace Factors
650			_aSex Factors
650			_aUnited States/ep [Epidemiology]
650			_aUrinary Bladder Neoplasms/pa [Pathology]
651			_aMedStar Health Research Institute
651			_aMedStar Washington Hospital Center
656			_aUrology
657			_aJournal Article
700			_aCarvalho, Filipe
700			_aEgan, Jillian
700			_aHwang, Jonathan J
700			_aKrasnow, Ross
700			_aLynch, John
700			_aMarinaro, Jessica
700			_aStamatakis, Lambros
700			_aZeymo, Alexander
790			_aCarvalho F, Egan J, Hwang J, Kowalczyk K, Krasnow R, Lynch J, Marinaro J, Stamatakis L, Williams S, Zeymo A
856			_uhttps://dx.doi.org/10.1016/j.urology.2020.06.087 _zhttps://dx.doi.org/10.1016/j.urology.2020.06.087
942			_cART _dArticle
999			_c5393 _d5393