Use of Restaging Bladder Tumor Resection for Bladder Cancer Among Medicare Beneficiaries

Objective To evaluate the use and effectiveness of restaging bladder tumor resection using population-based data. Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical imp...

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Veröffentlicht in:Urology (Ridgewood, N.J.) N.J.), 2011-12, Vol.78 (6), p.1345-1349
Hauptverfasser: Skolarus, Ted A, Ye, Zaojun, Montgomery, Jeffrey S, Weizer, Alon Z, Hafez, Khaled S, Lee, Cheryl T, Miller, David C, Wood, David P, Montie, James E, Hollenbeck, Brent K
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Sprache:eng
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Zusammenfassung:Objective To evaluate the use and effectiveness of restaging bladder tumor resection using population-based data. Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown. Methods We identified 62 016 patients diagnosed with bladder cancer between 1992 and 2005 using SEER−Medicare data. Restaging bladder tumor resection was defined as 2 or more resections occurring within 60 days of diagnosis. Using multivariable models, we assessed the relationship between the use of restaging resection and cancer-specific survival. Results Restaging resection was performed in only 3064 (4.9%) of newly diagnosed bladder cancer patients, but was most common among those with high grade (7.7% vs 2.0% in low grade, P < .001) and stage (8.8% in T2 vs 2.8% in Ta/Tis, P < .001) disease. Compared to patients with muscle-invasive cancers who did not undergo restaging at diagnosis, restaging resection was associated with improved 5-year cancer-specific mortality among pathologically staged patients (20.4% vs 28.0%, P = .02), while clinically staged patients trended toward improved mortality (28.2% vs 31.9%, P = .07). Conclusion Restaging transurethral resection for bladder cancer is relatively uncommon and associated with improved survival among patients with muscle invasive bladder cancer. Greater use of restaging warrants further investigation as a simple means of improving outcomes among patients suspected of having muscle invasive disease.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2011.05.071