Survival experience of black patients and white patients with bladder carcinoma

Authors

  • George R. Prout Jr. M.D.,

    1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
    Search for more papers by this author
    • George R. Prout, Jr. is a consultant to the NCI Division of Cancer Control and Population Sciences.

  • Margaret N. Wesley Ph.D.,

    1. Information Management Services, Inc., Silver Spring, Maryland
    Search for more papers by this author
  • Peter G. McCarron M.D., M.P.H.,

    1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
    Search for more papers by this author
  • Vivien W. Chen Ph.D.,

    1. Louisiana State University Health Sciences Center, Epidemiology Program, Louisiana Tumor Registry, New Orleans, Louisiana
    Search for more papers by this author
  • Raymond S. Greenberg M.D., Ph.D.,

    1. Medical University of South Carolina, Charleston, South Carolina
    Search for more papers by this author
  • Robert M. Mayberry M.P.H., Ph.D.,

    1. Program for Healthcare Effectiveness Research, Morehouse School of Medicine, Atlanta, Georgia
    Search for more papers by this author
  • Brenda K. Edwards Ph.D.

    Corresponding author
    1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
    • Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 6116 Executive Boulevard, Bethesda, MD 20892-8315
    Search for more papers by this author
    • Fax: (301) 480-4077


  • Senior staff at the NCI provided overall scientific direction and program management of the multicenter collaborative study conducted under contracts. They have shared responsibility for the design, conduct, interpretation, and analysis of study results as well as participating as coauthors of the submitted article based on established policy and procedures for governance of this multiinvestigator study. Review and clearance of the article was provided by NCI scientific staff other than the coauthors.

Abstract

BACKGROUND

Blacks are less likely than whites to develop bladder carcinoma. However, once they are diagnosed, black patients experience poorer survival. The authors investigated which factors were related to survival differences in black patients and white patients with bladder carcinoma stratified by extent of disease.

METHODS

A population-based cohort of black patients with bladder carcinoma and a random sample of frequency-matched white patients with bladder carcinoma, stratified by age and gender, were identified through cancer registry systems in Atlanta, New Orleans, and San Francisco/Oakland. Patients had no previous cancer history and were ages 20–79 years at the time they were diagnosed with bladder carcinoma in 1985–1987. Medical records were reviewed at initial diagnosis, and 77% of patients were interviewed. Tumor grade, T classification, and other variables, including age, socioeconomic position, symptom duration, smoking history, and comorbidities, were recorded. Survival of black patients and white patients by extent of disease was modeled using Cox regression analysis.

RESULTS

A greater proportion of black patients had histologic types of tumors that were associated with poorer survival. Among those with pure urothelial carcinoma, black patients had greater extent of disease at the time of diagnosis. Within specific extent-of-disease categories, there was some evidence of poorer survival for black patients with T2 tumors and strong evidence of poorer survival among those with T3 tumors compared with white patients. Black patients with muscle-invasive carcinoma who died within 6 months of diagnosis tended to present with life-threatening symptoms. Black patients and white patients did not differ with respect to diagnostic tests performed or therapy given.

CONCLUSIONS

Black patients with bladder carcinoma had poorer survival due to greater extent of disease at diagnosis and a higher proportion of more aggressive histologies compared with white patients. Within urothelial carcinomas, by extent of disease (clinical/pathologic stage) these black/white survival differences were limited to patients with muscle invasion (T2 and T3 tumors). Cancer 2004. Published 2003 by the American Cancer Society.

Ancillary