Background and Objectives: The National Cancer Database (NCDB) captures nearly 70% of all new cancer diagnoses in the United States, but there exists significant variation in this capture rate based on primary tumor location and other patient demographic factors. Prostate cancer has the lowest coverage rate of all major cancers, and other genitourinary malignancies likewise fall below the average NCDB case coverage rate. We aimed to explore NCDB coverage rates for patients with genitourinary cancers as a function of race. Materials and Methods: We compared the incidence of cancer cases in the NCDB with contemporary United States Cancer Statistics data. Results: Across all malignancies, American Indian/Alaskan Natives subjects demonstrated the lowest capture rates, and Asian/Pacific Islander subjects exhibited the second-lowest capture rates. Between White and Black subjects, capture rates were significantly higher for White subjects overall and for prostate cancer and kidney cancer in White males, but significantly higher for bladder cancer in Black versus White females. No significant differences were observed in coverage rates for kidney cancer in females, bladder cancer in males, penile cancer, or testicular cancer in White versus Black patients. Conclusions: Differential access to Commission on Cancer-accredited treatment facilities for racial minorities with genitourinary cancer constitutes a unique avenue for health equity research.

In a previous study we reported that molecular profiling of bladder mucosal tissue from a modest number of IC/BPS patients resulted in a clear separation based on anesthetic bladder capacity (BC), with 400 cc representing the apparent breakpoint between low and non-low BC. The purpose of the current study was to revisit this earlier stratification finding, using a combination of molecular and clinical data, from a large and heterogeneous patient cohort. To provide an updated assessment of IC/BPS patient stratification based on anesthetic BC, whole genome gene expression data from 48 mucosal biopsy samples (41 IC/BPS patients; 7 controls) were analyzed with unsupervised clustering and principal component analysis (PCA) to identify primary clusters of patients. This identified three primary individual clusters: (1) IC/BPS patients with a BC between 200–500 cc (n=19), (2) IC/BPS patients with a BC of 501–1500 cc (n=22), and (3) controls. Next, complete demographic, clinical, and questionnaire data prospectively collected from an additional 450 patients from our patient registry were used to conduct a combined analysis to verify this relationship. Characteristics of all 491 IC/BPS patients were compared between those having the current low BC cutoff (≤ 400 cc) and the proposed new cutoff (500 cc) by utilizing independent samples t-test (continuous variables) and chi square tests (categorical variables; p ≤ 0.05 was considered significant). A statistical comparison of the demographic and clinical characteristics of the entire 491 IC/BPS patient cohort showed that those with a bladder capacity ≤ 500 cc were older, were more likely to have Hunner lesions, and had higher symptom scores. This group also had a lower average number of non-urologic associated symptoms, pelvic pain syndromes, and neurologic, immune, or systemic pain syndromes. By combining newly acquired molecular data with clinical and demographic characteristics in a large cohort of IC/BPS patients, we conclude that anesthetic BC ≤ 500 cc provides a clinically meaningful biomarker for the bladder centric IC/BPS phenotypic subgroup.

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien–Dindo (C.D.) complication rates (Minor C.D. I–II, Major C.D. III–V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any—69% vs. 77%; minor—61% vs. 73%; major—46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.