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Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer

Holmberg, Lars ; Hagberg, Oskar LU ; Häggström, Christel ; Gårdmark, Truls ; Ströck, Viveka ; Aljabery, Firas ; Jahnson, Staffan ; Hosseini, Abolfazl ; Jerlström, Tomas and Sherif, Amir , et al. (2022) In PLoS ONE 17(9 September).
Abstract

Background Previous research has associated repeated transurethral procedures after a diagnosis of non-muscle invasive bladder cancer (NMIBC) with increased risk of death of causes other than bladder cancer. Aim We investigated the overall and disease-specific risk of death in patients with NMIBC compared to a background population sample. Methods We utilized the database BladderBaSe 2.0 containing tumor-specific, health-related and socio-demographic information for 38,547 patients with NMIBC not primarily treated with radical cystectomy and 192,733 individuals in a comparison cohort, matched on age, gender, and county of residence. The cohorts were compared using Kaplan-Meier curves and Hazard ratios (HR) from a Cox regression models.... (More)

Background Previous research has associated repeated transurethral procedures after a diagnosis of non-muscle invasive bladder cancer (NMIBC) with increased risk of death of causes other than bladder cancer. Aim We investigated the overall and disease-specific risk of death in patients with NMIBC compared to a background population sample. Methods We utilized the database BladderBaSe 2.0 containing tumor-specific, health-related and socio-demographic information for 38,547 patients with NMIBC not primarily treated with radical cystectomy and 192,733 individuals in a comparison cohort, matched on age, gender, and county of residence. The cohorts were compared using Kaplan-Meier curves and Hazard ratios (HR) from a Cox regression models. In the NMIBC cohort, we analyzed the association between number of transurethral procedures and death conditioned on surviving two or five years. Results Overall survival and survival from causes other than bladder cancer estimated with Kaplan- Meier curves was 9.3% (95% confidence interval (CI) (8.6%-10.0%)) and 1.4% (95% CI 0.7%-2.1%) lower respectively for the NMIBC cohort compared to the comparison cohort at ten years. In a Cox model adjusted for prognostic group, educational level and comorbidity, the HR was 1.03 (95% CI 1.01-1.05) for death from causes other than bladder cancer comparing the NMIBC cohort to the comparison cohort. Among the NMIBC patients, there was no discernible association between number of transurethral procedures and deaths of causes other than bladder cancer after adjustment. The number of procedures were, however, associated with risk of dying from bladder cancer HR 3.56 (95% CI 3.43-3.68) for four or more resections versus one within two years of follow-up. Conclusion The results indicate that repeated diagnostic or therapeutic transurethral procedures under follow-up do not increase of risk dying from causes other than bladder cancer. The modestly raised risk for NMIBC patients dying from causes other than bladder cancer is likely explained by residual confounding.

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type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
17
issue
9 September
article number
e0274859
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:85138468250
  • pmid:36149914
ISSN
1932-6203
DOI
10.1371/journal.pone.0274859
language
English
LU publication?
yes
id
9eaa893b-617f-4644-b2f7-9f6349e28087
date added to LUP
2023-01-19 13:37:42
date last changed
2024-05-30 22:28:37
@article{9eaa893b-617f-4644-b2f7-9f6349e28087,
  abstract     = {{<p>Background Previous research has associated repeated transurethral procedures after a diagnosis of non-muscle invasive bladder cancer (NMIBC) with increased risk of death of causes other than bladder cancer. Aim We investigated the overall and disease-specific risk of death in patients with NMIBC compared to a background population sample. Methods We utilized the database BladderBaSe 2.0 containing tumor-specific, health-related and socio-demographic information for 38,547 patients with NMIBC not primarily treated with radical cystectomy and 192,733 individuals in a comparison cohort, matched on age, gender, and county of residence. The cohorts were compared using Kaplan-Meier curves and Hazard ratios (HR) from a Cox regression models. In the NMIBC cohort, we analyzed the association between number of transurethral procedures and death conditioned on surviving two or five years. Results Overall survival and survival from causes other than bladder cancer estimated with Kaplan- Meier curves was 9.3% (95% confidence interval (CI) (8.6%-10.0%)) and 1.4% (95% CI 0.7%-2.1%) lower respectively for the NMIBC cohort compared to the comparison cohort at ten years. In a Cox model adjusted for prognostic group, educational level and comorbidity, the HR was 1.03 (95% CI 1.01-1.05) for death from causes other than bladder cancer comparing the NMIBC cohort to the comparison cohort. Among the NMIBC patients, there was no discernible association between number of transurethral procedures and deaths of causes other than bladder cancer after adjustment. The number of procedures were, however, associated with risk of dying from bladder cancer HR 3.56 (95% CI 3.43-3.68) for four or more resections versus one within two years of follow-up. Conclusion The results indicate that repeated diagnostic or therapeutic transurethral procedures under follow-up do not increase of risk dying from causes other than bladder cancer. The modestly raised risk for NMIBC patients dying from causes other than bladder cancer is likely explained by residual confounding.</p>}},
  author       = {{Holmberg, Lars and Hagberg, Oskar and Häggström, Christel and Gårdmark, Truls and Ströck, Viveka and Aljabery, Firas and Jahnson, Staffan and Hosseini, Abolfazl and Jerlström, Tomas and Sherif, Amir and Söderkvist, Karin and Ullén, Anders and Enlund, Mats and Liedberg, Fredrik and Malmström, Per Uno}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{9 September}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Number of transurethral procedures after non-muscle-invasive bladder cancer and survival in causes other than bladder cancer}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0274859}},
  doi          = {{10.1371/journal.pone.0274859}},
  volume       = {{17}},
  year         = {{2022}},
}