Klaassen Zachary, DiBianco John M, Jen Rita P, Evans Austin J, Reinstatler Lael, Terris Martha K, Madi Rabii
Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
Section of Urology, Medical College of Georgia, Augusta University, Augusta, GA.
Clin Genitourin Cancer. 2016 Oct;14(5):e489-e492. doi: 10.1016/j.clgc.2016.04.006. Epub 2016 Apr 29.
Although there are well-established risk factors for the diagnosis of bladder cancer, there is no consensus regarding risk factors for presentation of advanced or metastatic disease at diagnosis. The objective of this study was to identify the demographic and clinical factors associated with metastasis at diagnosis in patients with bladder urothelial carcinoma.
Patients diagnosed with bladder urothelial carcinoma from 2004 to 2010 were identified in the Surveillance, Epidemiology, and End Results (SEER) database (n = 108,417). The primary outcome was metastatic disease at the time of diagnosis. Demographic and socioeconomic variables were analyzed, and multivariable logistic regression models were performed to generate odds ratios (OR) for factors associated with metastasis at diagnosis.
Of patients with bladder cancer, 3018 (2.8%) had metastasis at diagnosis and 105,399 (97.2%) had nonmetastatic disease. Patients with metastatic disease at diagnosis were more frequently female (29.6% vs. 23.6%, P < .001), black (9.4% vs. 5.0%, P < .001), and unmarried (44.1% vs. 32.5%, P < .001) compared to patients with nonmetastatic disease. On multivariable analysis, the following characteristics were confirmed to be independently associated with metastatic disease at diagnosis: female gender (vs. male, OR 1.21), black race (vs. white, OR 1.71), unmarried (vs. married, OR 1.46), unemployed (OR 1.02), and foreign-born status (OR 1.01).
Female gender, black race, unmarried, unemployed, and foreign-born status are independently associated with metastasis at diagnosis for bladder urothelial carcinoma. All clinicians should be aware of these potential health care disparities in order to involve social services and other support mechanisms in efforts to improve early care.
尽管膀胱癌诊断存在公认的危险因素，但对于诊断时出现晚期或转移性疾病的危险因素尚无共识。本研究的目的是确定膀胱尿路上皮癌患者诊断时与转移相关的人口统计学和临床因素。
在监测、流行病学和最终结果（SEER）数据库中识别出2004年至2010年诊断为膀胱尿路上皮癌的患者（n = 108,417）。主要结局是诊断时的转移性疾病。分析了人口统计学和社会经济变量，并进行多变量逻辑回归模型以生成诊断时与转移相关因素的比值比（OR）。
在膀胱癌患者中，3018例（2.8%）诊断时出现转移，105,399例（97.2%）患有非转移性疾病。与非转移性疾病患者相比，诊断时患有转移性疾病的患者女性比例更高（29.6%对23.6%，P <.001）、黑人比例更高（9.4%对5.0%，P <.001）、未婚比例更高（44.1%对32.5%，P <.001）。多变量分析显示，以下特征被证实与诊断时的转移性疾病独立相关：女性（与男性相比，OR 1.21）、黑人种族（与白人相比，OR 1.71）、未婚（与已婚相比，OR 1.46）、失业（OR 1.02）和外国出生身份（OR 1.01）。
女性、黑人种族、未婚、失业和外国出生身份与膀胱尿路上皮癌诊断时的转移独立相关。所有临床医生都应意识到这些潜在的医疗保健差异，以便让社会服务和其他支持机制参与到改善早期护理的努力中。
