Cancer-specific survival by stage of bladder cancer and factors collected by Mallorca Cancer Registry associated to survival

Abstract

Background: Information about survival by stage in bladder cancer is scarce, as well as about survival of non-invasive bladder cancer. The aims of this study are: 1) to find out the distribution of bladder cancer by stage; 2) to determine cancer-specific survival by stage of bladder cancer; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers. Methods: Incident bladder cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with code C67 according to the ICD-O 3rd edition with any behaviour and any histology, except lymphomas and small cell carcinomas. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis. Results: One thousand nine hundred fourteen cases were identified. 14% were women and 65.4% were 65 years or older. 3.9% had no stage (benign or undetermined behaviour) and 11.5% had unknown stage. After MI, 37.5% were in stage Ta (non-invasive papillary carcinoma), 3.2% in stage Tis (carcinoma in situ), 34.3% in stage I, 11.7% in Stage II, 4.3% in stage III, and 9.0% in stage IV. Survival was 76% at 5 years. Survival by stage: 98% at stage Ta, 90% at stage Tis, 85% at stage I, 45% at stage II, 35% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage, but not sex, were associated with survival. Conclusion: Bladder cancer survival vary greatly with stage, among both non-invasive and invasive cases. The percentage of non-invasive cancers is high. Stage, age, and histology are associated to survival.