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Socioeconomic Factors, Urological Epidemiology and Practice Patterns
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SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
robustness of the gene expression signature was validated in an independent (n ⫽ 353) cohort. Results: Supervised analysis of gene expression data revealed a gene expression signature that is strongly associated with invasive bladder tumors. A molecular classifier based on this gene expression signature correctly predicted the likelihood of progression of superficial tumor to invasive tumor. Conclusion: We present a molecular signature that can predict, at diagnosis, the likelihood of bladder cancer progression and, possibly, lead to improvements in patient therapy. Editorial Comment: Not all tumors in the same stage behave the same. There are good and bad actors—the key is to discriminate between the two. Prognostic genetic testing may be an answer in the near future but for now we should rely more on the histological growth pattern of the tumor. Pathologists should be more descriptive in their reports and urologists more inquisitive when their intuition tells them a particular tumor seems worse than the pathology report would suggest. David P. Wood, M.D.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Marital Status and Survival Following Bladder Cancer G. D. Datta, B. A. Neville, I. Kawachi, N. S. Datta and C. C. Earle Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts J Epidemiol Community Health 2009; 63: 807– 813.
Background: Marital status has been implicated as a prognostic factor in bladder cancer survival. However, few studies have explored potential mechanisms through which this might occur. Methods: The study identified 19,982 bladder cancer patients from the SEER-Medicare database (1992– 8) and constructed sex-specific Cox proportional hazard models to assess the relation between marital status and 5-year survival, while sequentially adding covariates to test possible mechanisms. Results: Multivariable Cox analyses suggest that at every stage, married men had better survival than unmarried men independent of age, race, ecologic socioeconomic status, comorbidities, any or aggressive treatment (assessed separately), and accessing a teaching hospital (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.74 to 0.87). Among women with stages II–IV bladder cancer, age and the presence of comorbid conditions explained the association between marital status and survival. However, among those diagnosed with stage I bladder cancer, none of the covariates explained the association between marital status and decreased mortality (fully adjusted HR 0.72; 95% CI 0.62 to 0.84). Conclusion: The lack of evidence of mediation through treatment, overall health, SES, or quality of healthcare institution among married men and women with stage I disease suggests they may be benefiting from something other than these factors, perhaps practical or social support. Editorial Comment: There is a sizeable literature showing a relationship between marital status and outcomes in various health conditions, so it is not that surprising to see that a relationship exists for bladder cancer. What is interesting is that it is somewhat different for different genders. For men the association persists independent of bladder cancer stage. However, in women an independent association between marital status and survival is noted in stage I disease but not in higher stage, muscle invasive disease. It is hard for me to explain these observed differences. David F. Penson, M.D., M.P.H.
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS
robustness of the gene expression signature was validated in an independent (n ⫽ 353) cohort. Results: Supervised analysis of gene expression data revealed a gene expression signature that is strongly associated with invasive bladder tumors. A molecular classifier based on this gene expression signature correctly predicted the likelihood of progression of superficial tumor to invasive tumor. Conclusion: We present a molecular signature that can predict, at diagnosis, the likelihood of bladder cancer progression and, possibly, lead to improvements in patient therapy. Editorial Comment: Not all tumors in the same stage behave the same. There are good and bad actors—the key is to discriminate between the two. Prognostic genetic testing may be an answer in the near future but for now we should rely more on the histological growth pattern of the tumor. Pathologists should be more descriptive in their reports and urologists more inquisitive when their intuition tells them a particular tumor seems worse than the pathology report would suggest. David P. Wood, M.D.
Socioeconomic Factors, Urological Epidemiology and Practice Patterns Marital Status and Survival Following Bladder Cancer G. D. Datta, B. A. Neville, I. Kawachi, N. S. Datta and C. C. Earle Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts J Epidemiol Community Health 2009; 63: 807– 813.
Background: Marital status has been implicated as a prognostic factor in bladder cancer survival. However, few studies have explored potential mechanisms through which this might occur. Methods: The study identified 19,982 bladder cancer patients from the SEER-Medicare database (1992– 8) and constructed sex-specific Cox proportional hazard models to assess the relation between marital status and 5-year survival, while sequentially adding covariates to test possible mechanisms. Results: Multivariable Cox analyses suggest that at every stage, married men had better survival than unmarried men independent of age, race, ecologic socioeconomic status, comorbidities, any or aggressive treatment (assessed separately), and accessing a teaching hospital (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.74 to 0.87). Among women with stages II–IV bladder cancer, age and the presence of comorbid conditions explained the association between marital status and survival. However, among those diagnosed with stage I bladder cancer, none of the covariates explained the association between marital status and decreased mortality (fully adjusted HR 0.72; 95% CI 0.62 to 0.84). Conclusion: The lack of evidence of mediation through treatment, overall health, SES, or quality of healthcare institution among married men and women with stage I disease suggests they may be benefiting from something other than these factors, perhaps practical or social support. Editorial Comment: There is a sizeable literature showing a relationship between marital status and outcomes in various health conditions, so it is not that surprising to see that a relationship exists for bladder cancer. What is interesting is that it is somewhat different for different genders. For men the association persists independent of bladder cancer stage. However, in women an independent association between marital status and survival is noted in stage I disease but not in higher stage, muscle invasive disease. It is hard for me to explain these observed differences. David F. Penson, M.D., M.P.H.