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Urol Ann. 2016 Apr-Jun;8(2):178-83. doi: 10.4103/0974-7796.164852.

Disparities in long-term radiographic follow-up after cystectomy for bladder cancer: Analysis of the SEER-Medicare database.

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Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Urology, University of Oklahoma, School of Medicine, Oklahoma City, Oklahoma, USA.



It is uncertain whether there are disparities related to receiving long-term radiographic follow-up after cystectomy performed for bladder cancer, and whether intensive follow-up influences survival.


We analyzed 2080 patients treated with cystectomy between 1992 and 2004 isolated from the SEER-Medicare database. The number of abdominal computerized tomography scans performed in patients surviving 2 years after surgery was used as an indicator of long-term radiographic follow-up to exclude patients with early failures.


Patients were mainly males (83.18%), had a mean age at diagnosis of 73.4 ± 6.6 (standard deviation) years, and mean survival of 4.6 ± 3.2 years. Multivariate analysis showed age >70 (odds ratio [OR]: 0.796, 95% confidence interval [CI]: 0.651-0.974), African American race (OR: 0.180, 95% CI: 0.081-0.279), and Charlson comorbidity score >2 (OR: 0.694, 95% CI: 0.505-0.954) to be associated with lower odds of long-term radiographic follow-up. Higher disease stage (Stage T4N1) (OR: 1.873, 95% CI: 1.491-2.353), higher quartile for education (OR: 5.203, 95% CI: 1.072-9.350) and higher quartile for income (OR: 6.940, 95% CI: 1.444-12.436) were associated with increased odds of long-term radiographic follow-up. Interestingly, more follow-up with imaging after cystectomy did not improve cancer-specific or overall survival in these patients.


There are significant age, race, and socioeconomic disparities in long-term radiographic follow-up after radical cystectomy. However, more radiographic follow-up may not be associated with better survival.


Bladder cancer; cystectomy; imaging; surveillance

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