Finocchiaro Alessio, Tylecki Anna, Stephens Alex, Viganó Silvia, Bertini Alessandro, Briganti Alberto, Montorsi Francesco, Salonia Andea, Lughezzani Giovanni, Buffi Nicoló, Ficarra Vincenzo, Di Trapani Ettore, Sood Akshay, Rogers Craig, Abdollah Firas
VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
World J Urol. 2025 Jun 2;43(1):349. doi: 10.1007/s00345-025-05722-1.
Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy with limited survival improvements despite advancements in treatment. Socioeconomic disparities significantly affect patient outcomes, yet the Area Deprivation Index (ADI), a robust measure of socioeconomic status, has been underexplored in MIBC. This study evaluates the association between ADI and cancer-specific mortality (CSM) in MIBC.
We retrospectively reviewed patients with MIBC (≥ T2; Any N; Any M) from the Michigan Department of Health and Human Services database (2004-2019). ADI scores were assigned based on residential census block groups and stratified into quartiles, with the 4th quartile (ADI 75-100) being the most deprived. Cumulative incidence functions compared CSM between quartiles, and competing-risk regression analysis assessed the association between ADI and CSM after adjusting for covariates.
Among 6120 patients (90% Non-Hispanic Whites; median age 73 [IQR 64-81]), most resided in metropolitan areas (80%) and were insured through Medicare (35%). Patients were distributed across ADI quartiles: 437 (1st), 1442 (2nd), 2171 (3rd), and 2070 (4th). At 10 years, CSM rates were 50%, 52%, 54%, and 55% for the 1st, 2nd, 3rd, and 4th quartiles, respectively (p = 0.01). Patients in the 3rd and 4th quartiles had 1.25 (HR 1.25, 95% CI 1.07-1.47, p = 0.016) and 1.30 (HR 1.30, 95% CI 1.11-1.54, p = 0.005) higher risks of CSM than those in the 1st quartile.
Higher ADI was associated with increased CSM in our cohort. Further studies are needed to explore potential causal mechanisms.
肌肉浸润性膀胱癌（MIBC）是一种侵袭性恶性肿瘤，尽管治疗取得了进展，但生存率改善有限。社会经济差异显著影响患者预后，然而，作为社会经济地位有力衡量指标的地区贫困指数（ADI）在MIBC中的研究却不足。本研究评估了MIBC中ADI与癌症特异性死亡率（CSM）之间的关联。
我们回顾性分析了密歇根州卫生与公众服务部数据库（2004 - 2019年）中患有MIBC（≥T2；任何N分期；任何M分期）的患者。根据居住普查街区组分配ADI分数，并分为四分位数，第4四分位数（ADI 75 - 100）表示最贫困。累积发病率函数比较了四分位数之间的CSM，竞争风险回归分析在调整协变量后评估了ADI与CSM之间的关联。
在6120例患者中（90%为非西班牙裔白人；中位年龄73岁[四分位间距64 - 81岁]），大多数居住在大都市地区（80%），并通过医疗保险参保（35%）。患者分布在ADI四分位数中：437例（第1四分位数）、1442例（第2四分位数）、2171例（第3四分位数）和2070例（第4四分位数）。在10年时，第1、2、3和4四分位数的CSM率分别为50%、52%、54%和55%（p = 0.01）。第3和第4四分位数的患者CSM风险分别比第1四分位数的患者高1.25倍（风险比1.25，95%置信区间1.07 - 1.47，p = 0.016）和1.30倍（风险比1.30，95%置信区间1.11 - 1.54，p = 0.005）。
在我们的队列中，较高的ADI与CSM增加相关。需要进一步研究来探索潜在的因果机制。
