The effect of race/ethnicity on cancer-specific mortality after trimodal therapy

Mario de Angelis; Andrea Baudo; Carolin Siech; Letizia Maria Ippolita Jannello; Francesco Di Bello; Jordan A Goyal; Zhe Tian; Nicola Longo; Ottavio de Cobelli; Felix K H Chun; Fred Saad; Shahrokh F Shariat; Luca Carmignani; Giorgio Gandaglia; Marco Moschini; Francesco Montorsi; Alberto Briganti; Pierre I Karakiewicz

doi:10.1007/s40615-024-01973-7

The effect of race/ethnicity on cancer-specific mortality after trimodal therapy

J Racial Ethn Health Disparities. 2024 Mar 20. doi: 10.1007/s40615-024-01973-7. Online ahead of print.

Authors

Mario de Angelis^{1

2

3}, Andrea Baudo^{4

5}, Carolin Siech^{4

6}, Letizia Maria Ippolita Jannello^{4

7}, Francesco Di Bello^{4

8}, Jordan A Goyal⁴, Zhe Tian⁴, Nicola Longo⁸, Ottavio de Cobelli⁷, Felix K H Chun⁶, Fred Saad⁴, Shahrokh F Shariat^{9

10

11

12}, Luca Carmignani⁵, Giorgio Gandaglia^{13

14}, Marco Moschini^{13

14}, Francesco Montorsi^{13

14}, Alberto Briganti^{13

14}, Pierre I Karakiewicz⁴

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada. deangelis.mario@hsr.it.
² Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. deangelis.mario@hsr.it.
³ Vita-Salute San Raffaele University, Milan, Italy. deangelis.mario@hsr.it.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁵ Department of Urology, IRCCS Policlinico San Donato, Milan, Italy.
⁶ Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.
⁷ Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
⁸ Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
⁹ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹¹ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹² Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹³ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁴ Vita-Salute San Raffaele University, Milan, Italy.

PMID: 38509444
DOI: 10.1007/s40615-024-01973-7

Abstract

Introduction: Trimodal therapy (TMT) is the most validated bladder-sparing treatment for organ-confined urothelial carcinoma of the urinary bladder (OC UCUB, namely cT2N0M0). However, it is unknown if barriers to the use of TMT or cancer-specific mortality (CSM) differences exist according to race/ethnicity. We addressed this knowledge gap.

Material and methods: Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified OC UCUB patients aged from 18 to 85 treated with radical cystectomy (RC) or TMT. Temporal trends described TMT versus RC use over time. Subsequently, in the subgroup of TMT-treated patients, survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression (MCR) models addressed CSM according to race/ethnicity.

Results: Among 19,501 assessable patients, 15,336 (79%) underwent RC versus 4165 TMT (21%). Overall, of all races/ethnicities, 16,245 (83.3%) were White Americans, 1215 (6.3%) Hispanics, 1160 (5.9%) African Americans, and 881 (4.5%) Asian/Pacific Islanders. Among TMT-treated patients, 3460 (83.1%) were White Americans, 298 (7.1%) African Americans, 218 (5.3%) Hispanics, and 189 (4.5%) Asian/Pacific Islanders. The lowest rate of TMT use relative to RC and TMT patients was recorded in Hispanics (17.9%). Over time, TMT use increased in White Americans (EAPC: + 4.5%, p = 0.001) and Asians/Pacific Islanders (EAPC: + 5.2%, p = 0.003), but not in others. Kaplan-Meier analyses showed median CSM of 49 months, 41 months, and 34 months and not reached in White Americans, Hispanics, African Americans, and Asian/Pacific Islanders, respectively (p = 0.02). In MCR models, two race/ethnicity subgroups independently predicted either worse (African Americans, HR: 1.20, p = 0.02) or better CSM (Asian/Pacific Islanders, HR: 0.75, p = 0.02).

Conclusion: Race/ethnicity affects both access to TMT (lower access in Hispanics) as well as survival after TMT (better in Asians/Pacific Islanders and worse in African Americans).

Keywords: Bladder cancer; Cancer-specific mortality; MIBC; Race ethnicity; TMT; Trimodal therapy; Urothelial carcinoma.