Rosiello Giuseppe, Palumbo Carlotta, Deuker Marina, Stolzenbach Lara Franziska, Martin Thomas, Tian Zhe, Gallina Andrea, Montorsi Francesco, Black Peter, Kassouf Wassim, Shariat Shahrokh F, Saad Fred, Briganti Alberto, Karakiewicz Pierre I
Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cent European J Urol. 2020;73(4):407-415. doi: 10.5173/ceju.2020.0269. Epub 2020 Oct 31.
Bladder cancer is the second most common genitourinary malignancy in the United States. The incidence of bladder cancer rises with age, and it is two times more common in Caucasians than in African-Americans (23.1 vs. 12.6 cases/100,000 persons). We aimed to investigate the racial and age-related differences in the distribution of metastasis in a large, contemporary cohort of metastatic bladder cancer patients.
Within the National Inpatient Sample database (2008-2015) we identified 5,767 patients with metastatic bladder cancer. Trend test, Chi-square test and multivariable logistic regression models were used to evaluate the relationship between ethnicity, age, and site of metastasis.
Of 5,767 patients with metastatic bladder cancer, 598 (10.4%) were African-American. Lung was the most common metastatic site in African-Americans (28.6%) vs. bone in Caucasians (21.7%). Overall, African-Americans showed higher rates of lung (+10.2%), liver (+7.5%) and bone (+5.2%) metastases, compared to Caucasians (all p <0.01). Brain metastases were rare in both ethnicities (3.3 vs. 2.4%; p = 0.2). Rates of exclusive bone, lung or liver metastases increased with age, but were higher in African-Americans, regardless of age strata. In the multivariable logistic regression models, African-American ethnicity independently predicted higher risk of lung (Odds ratio: 1.69), liver (odds ratio: 1.50) and bone (odds ratio: 1.27) metastases, relative to Caucasians. Moreover, a dose-response effect was found after combining the three main risk factors for developing bone metastases, namely African-American ethnicity, younger age and male gender.
Racial differences exist in the distribution of metastatic bladder cancer metastasis. Moreover, based on higher risk of bone metastases in African-American patients, bone imaging may be warranted in this patient population, especially in the presence of other risk factors for bone metastases, namely male gender or younger age.
膀胱癌是美国第二常见的泌尿生殖系统恶性肿瘤。膀胱癌的发病率随年龄增长而上升，在白种人中的发病率是非洲裔美国人的两倍（每10万人中分别为23.1例和12.6例）。我们旨在调查在一个大型当代转移性膀胱癌患者队列中转移分布的种族和年龄相关差异。
在国家住院样本数据库（2008 - 2015年）中，我们识别出5767例转移性膀胱癌患者。采用趋势检验、卡方检验和多变量逻辑回归模型来评估种族、年龄与转移部位之间的关系。
在5767例转移性膀胱癌患者中，598例（10.4%）为非洲裔美国人。肺是非洲裔美国人最常见的转移部位（28.6%），而白种人最常见的转移部位是骨（21.7%）。总体而言，与白种人相比，非洲裔美国人的肺转移（+10.2%）、肝转移（+7.5%）和骨转移（+5.2%）发生率更高（所有p<0.01）。脑转移在两个种族中都很罕见（3.3%对2.4%；p = 0.2）。单纯骨转移、肺转移或肝转移的发生率随年龄增加，但无论年龄层如何，非洲裔美国人的发生率更高。在多变量逻辑回归模型中，相对于白种人，非洲裔种族独立预测肺转移（比值比：1.69）、肝转移（比值比：1.50）和骨转移（比值比：1.27）的风险更高。此外，在合并发生骨转移的三个主要风险因素，即非洲裔种族、较年轻年龄和男性性别后，发现了剂量反应效应。
转移性膀胱癌的转移分布存在种族差异。此外，鉴于非洲裔美国患者骨转移风险较高，在该患者群体中可能需要进行骨成像检查，尤其是在存在其他骨转移风险因素，即男性性别或较年轻年龄的情况下。
