Zang Yan, Li Xiao, Cheng Yifei, Qi Feng, Yang Ningli
Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
Ann Transl Med. 2020 Dec;8(23):1587. doi: 10.21037/atm-20-2108.
To explore the overall trends of incidence rate (IR), mortality and survival outcomes of patients with urothelial bladder cancer (UBC) over the past two decades.
Patients diagnosed with UBC from 1993 to 2012 were extracted from the Surveillance, Epidemiology and End Result (SEER) 18 database. Baseline characteristics and treatment types of included patients were collected retrospectively. Moreover, the age-adjusted IRs and annual percent changes (APCs) were obtained. Afterwards, we calculated the standardized mortality ratios (SMRs) for bladder cancer (BC), cardiovascular disease (CVD) and all-cause mortality by comparing UBC cases with the general population. Finally, survival outcomes of UBC patients were analyzed and compared.
A total of 220,405 UBC patients were identified, including 167,036 (75.79%) male patients and 53,369 (24.21%) female patients, with an average age of 70.84 years old. Most patients were White (89.85%), with older age (71.67%, >65 years old), lower T stage diseases (78.11%, < T2) and lower median household income (55.37%). When compared with patients diagnosed between 1993 and 2002, those diagnosed between 2003 and 2012 had older age (mean: 71.15 70.16 years old, P<0.001), higher proportion of men (76.22% 74.83%, P<0.001) and lower median household income (56.69% 52.50%, P<0.01). Overall, the IR of UBC increased slightly before 2003 and maintained a stable trend of about 20 per 100,000 person-years after 2003. Additionally, CVD was recognized as an important cause of death (COD) of UBC patients. UBC patients were 44.5 times more likely to die of CVD when compared with the general population. Furthermore, the 3-, 5- and 10-year overall survival (OS) and cancer-specific survival (CSS) rates were 0.709, 0.609 and 0.421, and 0.861, 0.831 and 0.789, respectively. Finally, survival outcomes between patients diagnosed in the two periods (1993-2002 2003-2012) were not significantly different.
The IR of UBC increased slightly before 2003 and remained stable after 2003. UBC patients had higher CVD burden than the general population. Hence, cardiovascular health should be emphasized to reduce mortality after UBC diagnosis. Lastly, survival outcomes of UBC patients in the last two decades showed no significant difference.
探讨过去二十年中尿路上皮膀胱癌（UBC）患者的发病率、死亡率及生存结局的总体趋势。
从监测、流行病学和最终结果（SEER）18数据库中提取1993年至2012年诊断为UBC的患者。回顾性收集纳入患者的基线特征和治疗类型。此外，获得年龄调整发病率及年变化百分比（APC）。之后，通过将UBC病例与普通人群比较，计算膀胱癌（BC）、心血管疾病（CVD）及全因死亡率的标准化死亡比（SMR）。最后，分析并比较UBC患者的生存结局。
共识别出220,405例UBC患者，其中男性患者167,036例（75.79%），女性患者53,369例（24.21%），平均年龄70.84岁。大多数患者为白人（89.85%），年龄较大（71.67%，>65岁），T分期较低（78.11%，<T2）且家庭收入中位数较低（55.37%）。与1993年至2002年诊断的患者相比，2003年至2012年诊断的患者年龄更大（平均：71.15对70.16岁，P<0.001），男性比例更高（76.22%对74.83%，P<0.001）且家庭收入中位数更低（56.69%对52.50%，P<0.01）。总体而言，UBC发病率在2003年前略有上升，2003年后保持在每10万人年约20的稳定趋势。此外，CVD被认为是UBC患者的重要死亡原因。与普通人群相比，UBC患者死于CVD的可能性高44.5倍。此外，3年、5年和10年总生存率（OS）及癌症特异性生存率（CSS）分别为0.709、0.609和0.421，以及0.861、0.831和0.789。最后，两个时期（1993 - 2002年对2003 - 2012年）诊断的患者生存结局无显著差异。
UBC发病率在2003年前略有上升，2003年后保持稳定。UBC患者的CVD负担高于普通人群。因此，应强调心血管健康以降低UBC诊断后的死亡率。最后，过去二十年UBC患者的生存结局无显著差异。
