Presentation and Outcome Following Radical Cystectomy in
Hispanics with Bladder Cancer
M. Manoharan, R. Ayyathurai, R. de Los Santos, A. M. Nieder, M. S. Soloway
Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida, USA
ABSTRACT
Objective:6LJQL¿FDQWUDFLDODQGHWKQLFGLIIHUHQFHVLQWKHHSLGHPLRORJ\RIEODGGHUFDQFHU%&H[LVW6WXGLHVKDYHVKRZQ $IULFDQ$PHULFDQVWRKDYHORZHULQFLGHQFHRIEODGGHUFDQFHUWKDQ&DXFDVLDQVEXWKLJKHULQFLGHQFHRILQYDVLYH%&+LVSDQ
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Materials and Methods: %HWZHHQ-DQXDU\DQG0D\5&ZHUHSHUIRUPHG$OOUHOHYDQWGDWDZHUHFROOHFWHG DQGHQWHUHGLQWRDGDWDEDVH3DWLHQWVZHUHFDWHJRUL]HGE\HWKQLFLW\DV+LVSDQLFDQGQRQ+LVSDQLF:KLWH$IULFDQ$PHULFDQ DQGRWKHUPLQRULW\JURXSVZHUHH[FOXGHGEHFDXVHRIWKHVPDOOQXPEHU&RPSDUDWLYHDQDO\VLVRI+LVSDQLFDQGQRQ+LVSDQLF :KLWHSDWLHQWVZDVSHUIRUPHG
Results:SDWLHQWVZHUH+LVSDQLF0HDQIROORZXSSHULRGZDV6'PRQWKV&OLQLFDODQGSDWKRORJLFDOGDWD EHWZHHQWKHVHWZRJURXSVZHUHFRPSDUHG3UHF\VWHFWRP\7VWDJHZDVQRWVLJQL¿FDQWO\GLIIHUHQWEHWZHHQERWKJURXSV +RZHYHUDIWHU5&LQFLGHQFHRI7GLVHDVHLQ+LVSDQLFVZDVORZHUWKDQ&DXFDVLDQV7KLVGLIIHUHQFH VWDWLVWLFDOO\VLJQL¿FDQW3 LQGLFDWHVWKDW+LVSDQLFVZKRXQGHUJR5&SUHVHQWZLWKKLJKHUVWDJHGLVHDVH.DSODQ 0HLHUORJUDQNWHVWLQGLFDWHGDGLIIHUHQFHLQGLVHDVHIUHHVXUYLYDODQGGLVHDVHVSHFL¿FVXUYLYDOEHWZHHQWKHWZRJURXSV EXWKRZHYHULWGLGQRWUHDFKVWDWLVWLFDOVLJQL¿FDQFH/RJ5DQN3 3 1RVLJQL¿FDQWGLIIHUHQFHLQRYHUDOO VXUYLYDOZDVREVHUYHG3
Conclusions:+LVSDQLFSDWLHQWVPDQDJHGZLWK5&IRUEODGGHUFDUFLQRPDSUHVHQWZLWKKLJKHUVWDJHGLVHDVH
Key words: bladder cancer; cystectomy; Hispanic; Latino Int Braz J Urol. 2008; 34: 691-8
INTRODUCTION
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MATERIALS AND METHODS
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RESULTS
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Characteristics Non-Hispanics White Hispanic p Value
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Table 2 – T stage before Radical Cystectomy in Hispanic and non-Hispanic white patients.
Characteristics Non-Hispanics White Hispanic p Value
&OLQLFDOVWDJH
7
7
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Table 3 – Pathological T stage at Radical Cystectomy in Hispanic and non-Hispanic white patients.
Characteristics Non-Hispanics White Hispanic p Value
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7
7
Values are numbers and ( ) are percentages.
Figure 2 – Recurrence-free survival.
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CONFLICT OF INTEREST
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Dr. Antonio Augusto Ornellas
Section of Urology National Institute of Cancer and Hospital Mário Kröeff Rio de Janeiro, Brazil E-mail: [email protected]
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Accepted after revision: September 9, 2008
Correspondence address: 'U00DQRKDUDQ
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