The management and outcome of bladder carcinoma in Ontario, 1982-1994

BACKGROUND. To the authors' knowledge no previous study has described the m anagement and outcome of bladder carcinoma on a population-based level. The objective of the current study was to describe the characteristics, treatm ent, and outcome of newly diagnosed invasive bladder carcinoma (n = 20,822) reported in Ontario, Canada between 1982-1994. METHODS. Electronic records of invasive bladder carcinoma (International Cl assification of Diseases code 188) from the Ontario Cancer Registry were li nked to surgical and radiotherapy (RT) records. Bivariate and multivariate techniques were used to assess variations in the use of initial cystectomy and pelvic RT. The authors modeled the likelihood of death after diagnosis and the probability of cystectomy free survival. All analyses were controll ed for age, gender, histology, and year of diagnosis. RESULTS. The most common histologic type was papillary transitional cell ca rcinoma. Maximum initial treatment was comprised of total cystectomy (5.1%) , partial cystectomy or open excision (3.5%), pelvic RT (5.9%), transurethr al resection of the bladder (66.7%), or lesser or no procedures (18.7%). Th e use of total cystectomy and pelvic RT varied among the regions of Ontario . Overall 5-year survival was 58.8%, and was 86.5% for patients with papill ary histology. In multivariate analysis, although survival was similar amon g the regions, the relative risk of cystectomy conditional on survival vari ed. CONCLUSIONS, Papillary tumors portend a better survival than nonpapillary t umors. Variations in the use of total cystectomy and in the use of pelvic R T among the regions of Ontario did not appear to be associated with variati ons in survival. However, cystectomy free survival appeared to vary among t he regions. These results suggest that patients can be managed safely using a bladder-preserving approach. (C) 2000 American Cancer Society.