Risk of bladder cancer death in patients younger than 50 with non-muscle-invasive and muscle-invasive bladder cancer

Abstract

Introduction and objectives

Bladder cancer is primarily a disease of older age and little is known about the differences between patients diagnosed with bladder cancer at a younger versus older age. Our objectives were to compare bladder cancer specific survival in patients aged <50 versus those aged 50–70 at time of diagnosis.

Materials and methods

The Swedish bladder cancer database provided data on patient demographics, clinical characteristics and treatments for this observational study. Cox proportional hazard regression models were adjusted for appropriate variables. All analyses were stratified by disease stage (non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. Furthermore, we compared the frequency of lower urinary tract infections within 24 months prior to bladder cancer diagnosis by sex and age groups.

Results

The study included 15,452 newly-diagnosed BC patients (1997–2014); 1,207 (8%) patients were <50 whilst 14,245 (92%) were aged 50–70. Patients aged <50 at diagnosis were at a decreased risk of bladder cancer death (HR = 0.82, 95%CI: 0.68–0.99) compared to those aged 50–70. When stratified by non-muscle-invasive and muscle-invasive bladder cancer, this association remained in non-muscle-invasive patients only (<50, HR = 0.43, 95% CI: 0.28–0.64). The frequency of lower urinary tract infection diagnoses did not differ between younger and older patients in either men or women.

Conclusions

Patients diagnosed with non-muscle-invasive bladder cancer when aged <50 are at decreased risk of bladder cancer-specific death when compared to their older (50-70) counterparts. These observations raise relevant research questions about age-related differences in diagnostic procedures, clinical decision-making and, not least, potential differences in tumour biology.

Keywords:

• Age
• NMIBC
• MIBC
• bladder cancer death
• survival

Ethical approval

Research was approved by the Research Ethics Board of Uppsala University, Sweden (File no. 2015/277).

Acknowledgments

This project was made possible with help of the data collected in the SNRUBC, and we would like to thank the members of the SNRUBC: Viveka Ströck, Firas Abdul-Sattar Aljabery, Johan Johansson, Per-Uno Malmström, Malcolm Carringer, Abolfazl Hosseini-Aliabad, Truls Gårdmark, Amir Sherif, Roland Rux, Markus Johansson, Petter Kollberg, Anna-Karin Lind, Jenny Wanegård, Magdalena Cwikiel, Elisabeth Överholm, Anders Ullen, Erika Jonsson, Helena Thulin, Gun Danielsson, Helene Hummer, Fredrik Liedberg, and Staffan Jahnson.

Author contributions

Study design – All authors. Data analysis – BR, OH, FL, LH, MVH. Writing and review of the manuscript – All authors.

Disclosure statemet

No potential conflict of interest was reported by the author(s).

Data availability statement

The BladderBaSe data is held on a secure server and is therefore not publicly available. However, applications to access the data can be made by contacting [email protected].