Nationwide analysis of survival after radical cystectomy for bladder cancer in Finland

Figures & data

Figure 1. The incidence of BC and RCs performed in Finland during 2005–2017.

Table 1. Basic characteristics of the study population.

Characteristic	High^a volume centers, N = 1358	Medium^b volume centers, N = 504	Low^c volume centers, N = 185	Overall, N = 2047
Age, median (IQR^d)	68 (62, 74)	70 (64, 76)	69 (63, 75)	69 (62, 75)
BMI^5, median (IQR^d)	25 (22, 29)	26 (23, 28)	24 (20, 27)	25 (22, 29)
Gender, N(%)
Female	266 (20%)	100 (20%)	33 (18%)	399 (19%)
Male	1092 (80%)	404 (80%)	152 (82%)	1648 (81%)
Smoke, N(%)
Active	332 (24%)	88 (17%)	38 (20%)	458 (22%)
Never	232 (17%)	111 (22%)	41 (22%)	384 (19%)
Stopped	321 (24%)	79 (16%)	24 (13%)	424 (21%)
Not available	473(35%)	226 (45%)	82 (44%)	781 (38%)
ASA^f-class, N(%)
1	40 (3%)	36 (7%)	8 (4%)	84 (4%)
2	428 (32%)	193 (38%)	74 (40%)	695 (34%)
3	645 (48%)	241 (48%)	73 (39%)	959 (47%)
4	62 (5%)	27 (5%)	8 (4%)	97 (4%)
Not available	183 (13%)	7 (1%)	22 (12%)	212 (10%)
TUR-BT^g T-category, N(%)
T0	11 (1%)	6 (1%)	1 (1%)	18 (1%)
Ta-Tis-T1	330 (28%)	184 (39%)	45 (26%)	559 (31%)
T2	696 (60%)	269 (57%)	103 (59%)	1068 (59%)
T3	92 (8%)	11 (2%)	22 (13%)	125 (7%)
T4	35 (3%)	5 (1%)	3 (2%)	43 (2%)
pT-category, N(%)
T0	241 (18%)	98 (20%)	17 (10%)	356 (18%)
Ta-Tis-T1	287 (21%)	103 (21%)	47 (27%)	437 (22%)
T2	242 (18%)	81 (16%)	49 (28%)	372 (19%)
T3	351 (26%)	164 (33%)	44 (25%)	559 (28%)
T4	198 (15%)	47 (10%)	20 (11%)	265 (13%)
pN-category, N(%)
N-	902 (66%)	313 (62%)	79 (43%)	1294 (63%)
N+	286 (21%)	81 (16%)	28 (15%)	395 (19%)
Not performed	71 (5%)	5 (1%)	20 (11%)	96 (5%)
Not available	99 (7%)	105 (21%)	58 (31%)	262 (13%)
NAC^h, N(%)
Yes	261 (19%)	75 (15%)	34 (18%)	370 (18%)
No	1097(81%)	429 (85%)	151 (82%)	1677 (82%)

^aHigh volume: over 20 radical cystectomies per year.

^bMedium volume: 5–20 radical cystectomies per year.

^cLow volume: less than 5 radical cystectomies per year.

^dIQR: inter quartile range.

^eBMI: body mass index (kg/m²).

^fASA: American society of anesthesiologists classification.

^gTUR-BT: transurethral resection of bladder tumor.

^hNAC: Neoadjuvant chemotherapy.

Figure 2. A. Overall survival according to pT-category B. Cancer specific survival according to pT-category.

Table 2. Survival rates of the study population according to center volume.

	Overall Survival		Cancer Specific Survival
	5-y.	10-y.	5-y.	10-y.
High^a volume centers	67%	56%	74%	73%
Medium^b volume centers	65%	53%	73%	72%
Low^c volume centers	66%	55%	70%	68%
Overall	66%	55%	74%	72%

^aHigh volume: over 20 radical cystectomies per year.

^bMedium volume : 5–20 radical cystectomies per year.

^cLow volume: less than 5 radical cystectomies per year.

Table 3. Survival rates of the study population according to pT- and pN-category.

	Overall Survival			Cancer Specific Survival
	5-y.	10-y.	HR^1 (95% CI^2)	5-y.	10-y.	HR^a (95% CI^b)
pT-category
pT0	87%	74%		96%	93%
pTa-Tis-T1	85%	69%	1.2 (0.9–1.6)	91%	90%	1.4 (0.8–2.4)
pT2	70%	58%	1.9 (1.5–2.5)	78%	75%	4.1 (2.6–6.5)
pT3	50%	42%	3.3 (2.6–4.2)	56%	55%	9.0 (5.8–13.9)
pT4	41%	30%	4.7 (3.6–6.1)	47%	44%	12.9 (8.2–20.2)
pN-category
pN-	74%	62%		82%	80%
pN+	44%	34%	2.3 (1.9–2.7)	49%	48%	3.4 (2.8–4.1)
pNx	64%	54%	1.2 (1.0–1.5)	70%	69%	1.7 (1.4–2.2)

^aHR: Hazard Ratio.

^bCI: Confidence Interval.

STROBE statement—checklist of items that should be included in reports of observational studies.

	Item No	Recommendation	Page No
Title and abstract	1	(a) Indicate the study’s design with a commonly used term in the title or the abstract	1
		(b) Provide in the abstract an informative and balanced summary of what was done and what was found	2
Introduction
Background/rationale	2	Explain the scientific background and rationale for the investigation being reported	3
Objectives	3	State specific objectives, including any prespecified hypotheses	3
Methods
Study design	4	Present key elements of study design early in the paper	3
Setting	5	Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection	3
Participants	6	(a) Cohort study—Give the eligibility criteria, and the sources and methods of selection of participants. Describe methods of follow-up Case-control study—Give the eligibility criteria, and the sources and methods of case ascertainment and control selection. Give the rationale for the choice of cases and controls Cross-sectional study—Give the eligibility criteria, and the sources and methods of selection of participants	3–4
		(b)Cohort study—For matched studies, give matching criteria and number of exposed and unexposed Case-control study—For matched studies, give matching criteria and the number of controls per case	–
Variables	7	Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable	4
Data sources/measurement	8^a	For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group	4
Bias	9	Describe any efforts to address potential sources of bias	4
Study size	10	Explain how the study size was arrived at	4
Quantitative variables	11	Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why	4
Statistical methods	12	(a) Describe all statistical methods, including those used to control for confounding	4
		(b) Describe any methods used to examine subgroups and interactions	4
		(c) Explain how missing data were addressed	4
		(d) Cohort study—If applicable, explain how loss to follow-up was addressed Case-control study—If applicable, explain how matching of cases and controls was addressed Cross-sectional study—If applicable, describe analytical methods taking account of sampling strategy	–
		(e) Describe any sensitivity analyses	4-5
Results
Participants	13^a	(a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analyzed	5
		(b) Give reasons for nonparticipation at each stage	–
		(c) Consider use of a flow diagram	–
Descriptive data	14^a	(a) Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and potential confounders	5 Table 1.
		(b) Indicate number of participants with missing data for each variable of interest	Table 1.
		(c) Cohort study—Summarize follow-up time (eg, average and total amount)	5
Outcome data	15^a	Cohort study—Report numbers of outcome events or summary measures over time	5
		Case-control study—Report numbers in each exposure category, or summary measures of exposure	-
		Cross-sectional study—Report numbers of outcome events or summary measures	-
Main results	16	(a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included	5 Table 2− 3.
		(b) Report category boundaries when continuous variables were categorized	–
		(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period	–
Other analyses	17	Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses	5
Discussion
Key results	18	Summarize key results with reference to study objectives	5–6
Limitations	19	Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias	8
Interpretation	20	Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence	6–7
Generalizability	21	Discuss the generalizability (external validity) of the study results	8
Other information
Funding	22	Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based	10

^aGive information separately for cases and controls in case-control studies and, if applicable, for exposed and unexposed groups in cohort and cross-sectional studies.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe-statement.org.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Ilkka Nikulainen, upon reasonable request.

STROBE statement—checklist of items that should be included in reports of observational studies.

	Item No	Recommendation	Page No
Title and abstract	1	(a) Indicate the study’s design with a commonly used term in the title or the abstract	1
		(b) Provide in the abstract an informative and balanced summary of what was done and what was found	2
Introduction
Background/rationale	2	Explain the scientific background and rationale for the investigation being reported	3
Objectives	3	State specific objectives, including any prespecified hypotheses	3
Methods
Study design	4	Present key elements of study design early in the paper	3
Setting	5	Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection	3
Participants	6	(a) Cohort study—Give the eligibility criteria, and the sources and methods of selection of participants. Describe methods of follow-up Case-control study—Give the eligibility criteria, and the sources and methods of case ascertainment and control selection. Give the rationale for the choice of cases and controls Cross-sectional study—Give the eligibility criteria, and the sources and methods of selection of participants	3–4
		(b)Cohort study—For matched studies, give matching criteria and number of exposed and unexposed Case-control study—For matched studies, give matching criteria and the number of controls per case	–
Variables	7	Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable	4
Data sources/measurement	8^a	For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group	4
Bias	9	Describe any efforts to address potential sources of bias	4
Study size	10	Explain how the study size was arrived at	4
Quantitative variables	11	Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why	4
Statistical methods	12	(a) Describe all statistical methods, including those used to control for confounding	4
		(b) Describe any methods used to examine subgroups and interactions	4
		(c) Explain how missing data were addressed	4
		(d) Cohort study—If applicable, explain how loss to follow-up was addressed Case-control study—If applicable, explain how matching of cases and controls was addressed Cross-sectional study—If applicable, describe analytical methods taking account of sampling strategy	–
		(e) Describe any sensitivity analyses	4-5
Results
Participants	13^a	(a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analyzed	5
		(b) Give reasons for nonparticipation at each stage	–
		(c) Consider use of a flow diagram	–
Descriptive data	14^a	(a) Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and potential confounders	5 Table 1.
		(b) Indicate number of participants with missing data for each variable of interest	Table 1.
		(c) Cohort study—Summarize follow-up time (eg, average and total amount)	5
Outcome data	15^a	Cohort study—Report numbers of outcome events or summary measures over time	5
		Case-control study—Report numbers in each exposure category, or summary measures of exposure	-
		Cross-sectional study—Report numbers of outcome events or summary measures	-
Main results	16	(a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included	5 Table 2− 3.
		(b) Report category boundaries when continuous variables were categorized	–
		(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period	–
Other analyses	17	Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses	5
Discussion
Key results	18	Summarize key results with reference to study objectives	5–6
Limitations	19	Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias	8
Interpretation	20	Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence	6–7
Generalizability	21	Discuss the generalizability (external validity) of the study results	8
Other information
Funding	22	Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based	10

^aGive information separately for cases and controls in case-control studies and, if applicable, for exposed and unexposed groups in cohort and cross-sectional studies.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe-statement.org.