EURURO Vol. 72 No. 4

need to be interpreted within the limitations of the

observational study design. Notably, our analyses are

subject to selection bias, which we attempted to correct

using an IPTW-adjusted approach.

[10_TD$DIFF]

Nonetheless, several

unmeasured confounders related to patient, tumor, and

treatment characteristics may have impacted TMT or RC

allocation and contributed to the long-term OS difference

[2_TD$DIFF]

observed

[11_TD$DIFF]

in the present. In addition, we focused on OS, but

several other endpoints such as quality of life and treatment

costs need to be considered in the management of localized

muscle-invasive UCB

[10]

To summarize, we found that TMT was associated with

worse long-term OS relative to RC for localized muscle-

invasive UCB. However, the survival benefit of RC should be

weighed against the risks of surgery, especially in older

patients. These results are preliminary and emphasize the

need for a randomized controlled trial to compare TMT

versus RC.

Table 1 – Baseline characteristics for patients who received trimodal therapy or radical cystectomy for clinically localized muscle-invasive

urothelial carcinoma of the bladder in the unweighted

[4_TD$DIFF]

and weigthed study

[5_TD$DIFF]

populations from the National Cancer Data Base, 2004–2011

Characteristic

Unweighted study population

Weighted study population

Overall

TMT

SDF (%)

Overall

TMT

SDF (%)

Patients,

(%)

12 843 (100)

1257 (9.8)

11 586 (90.2)

–

Mean age, yr (SD)

68.8 (10.6)

74.8 (9.6)

68.1 (10.5)

66.4 68.8 (10.5)

69.0 (10.5)

68.8 (10.5)

2.1

Gender,

(%)

Male

9680 (75.4)

955 (76.0)

8725 (75.3)

1.6 75.5

76.3

75.4

2.0

Female

3163 (24.6)

302 (24.0)

2861 (24.7)

1.6 24.5

23.7

24.6

2.0

Race,

(%)

White

11 793 (91.8)

1133 (90.1)

10 660 (92.0)

6.6 91.7

90.5

91.8

4.4

Black

677 (5.3)

91 (7.2)

586 (5.1)

9.1

5.4

6.2

5.3

3.8

Other

229 (1.8)

17 (1.4)

212 (1.8)

3.8

1.8

0.4

Unknown

144 (1.1)

16 (1.3)

128 (1.1)

1.6

1.1

1.5

1.1

2.9

CCI,

(%)

9001 (70.1)

861 (68.5)

8140 (70.3)

3.8 69.8

67.8

70.0

4.8

2961 (23.1)

293 (23.3)

2668 (23.0)

0.7 23.2

23.7

23.1

1.6

881 (6.8)

103 (8.2)

778 (6.7)

5.6

7.0

8.5

6.9

5.9

Insurance type,

(%)

Private

3891 (30.3)

241 (19.2)

3650 (31.5)

28.6 30.1

27.8

30.3

5.5

Medicaid/other government

604 (4.7)

63 (5.0)

541 (4.7)

1.6

4.8

5.6

4.7

4.1

Medicare

7828 (60.9)

925 (73.6)

6903 (59.6)

30.0 61.1

62.7

60.9

3.8

No insurance

340 (2.7)

17 (1.3)

323 (2.8)

10.1

2.6

2.8

2.7

0.6

Unknown

180 (1.4)

11 (0.9)

169 (1.4)

5.4

1.4

1.1

1.4

3.0

Income level,

(%)

High

7281 (56.7)

702 (55.9)

6579 (56.8)

1.9 56.5

54.6

56.7

4.2

Low

5206 (40.5)

517 (41.1)

4689 (40.5)

1.3 40.8

43.1

40.5

5.2

Unknown

356 (2.8)

38 (3.0)

318 (2.7)

1.7

2.7

2.3

2.8

Education level,

(%)

High

7489 (58.3)

729 (58.0)

6760 (58.3)

0.7 58.3

58.3

0.2

Low

5006 (39.0)

490 (39.0)

4516 (39.0)

0.0 39.0

39.4

39.0

1.0

Unknown

348 (2.7)

38 (3.0)

310 (2.7)

2.1

2.7

2.3

2.7

2.5

County type,

(%)

Metropolitan

9890 (77.0)

985 (78.3)

8905 (76.9)

3.6 77.2

78.2

77.1

2.8

Urban

2068 (16.1)

186 (14.8)

1882 (16.2)

4.0 15.9

14.6

16.0

4.1

Rural

306 (2.4)

31 (2.5)

275 (2.4)

0.6

2.4

2.8

2.4

2.6

Unknown

579 (4.5)

55 (4.4)

524 (4.5)

0.7

4.5

4.4

4.5

0.5

Travel distance,

(%)

12.5 miles

5816 (45.3)

797 (63.4)

5019 (43.3)

41.1 45.7

50.0

45.3

9.3

12.5 miles

6690 (52.1)

422 (33.6)

6268 (54.1)

42.3 51.7

47.7

52.1

8.7

Unknown

337 (2.6)

38 (3.0)

299 (2.6)

2.7

2.6

2.3

2.6

1.9

Facility type,

(%)

Academic

6090 (47.4)

362 (28.8)

5728 (49.4)

43.3 47.0

43.0

47.4

8.9

Non-academic

6716 (52.3)

892 (71.0)

5824 (50.3)

43.3 52.7

56.9

52.3

9.3

Unknown

37 (0.3)

3 (0.2)

34 (0.3)

1.1

0.3

9.0e-04

0.3

4.5

Facility location,

(%)

East

5105 (39.8)

599 (47.7)

4506 (38.9)

17.8 39.9

41.3

39.7

3.1

Center

5548 (43.2)

458 (36.4)

5090 (43.9)

15.3 43.1

42.8

43.2

0.7

West

2190 (17.1)

200 (15.9)

1990 (17.2)

3.4 17.0

15.9

17.1

3.2

Year of diagnosis,

(%)

2004–2007

4780 (37.2)

572 (45.5)

4208 (36.3)

18.8 37.2

39.6

36.9

5.4

2008–2011

8063 (62.8)

685 (54.5)

7378 (63.7)

18.8 62.8

60.4

63.1

5.4

Clinical tumor stage,

(%)

cT2

10 312 (80.3)

1032 (82.1)

9280 (80.1)

5.1 80.2

79.4

80.3

2.3

cT3

1588 (12.4)

121 (9.6)

1467 (12.7)

9.7 12.4

12.4

0.0

cT4

943 (7.3)

104 (8.3)

839 (7.2)

3.9

7.4

8.2

7.4

3.4

TMT = trimodal therapy; RC = radical cystectomy; SDF = standardized difference; SD = standard deviation; CCI = Charlson comorbidity index.

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 8 3 – 4 8 7

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