Introduction & Objectives
The complexity of bladder cancer diagnosis and staging results in delays to definitive treatment of muscle-invasive bladder cancer by radical cystectomy. This systematic review and meta-analyses aim to assess the impact of delays to radical cystectomy.
Materials & Methods
A systematic review was conducted by searching Medline and Ovid Gateway using protocol-driven search terms between November 2018 and July 2019 with no time limit on the studies included. The identified studies were assessed according to strict criteria and were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Risk Of Bias In Non-randomised Studies – of Interventions (ROBINS-I) tool. Meta-analyses were conducted based on type of delay (Bladder cancer diagnosis to cystectomy; transurethral resection to cystectomy). Random-effects models were used whereby the presence of a delay was the exposure variable and overall survival was the outcome of interest, for which pooled hazard ratios were calculated.
Results
Eighteen studies were eligible for inclusion (17,306 patients), of which seven were included in the meta-analyses. When studying total delay between bladder cancer diagnosis and radical cystectomy, the meta-analysis revealed a pooled hazard ratio for overall death of 1.34 (95% CI: 1.18-1.53) when comparing those with a longer delay to those with a shorter delay. For delay between transurethral resection and cystectomy, we found a pooled hazard ratio of 1.21 (95% CI: 0.96-1.52) for death from all causes.
Conclusions
A delay in radical cystectomy after diagnosis was found to have a significantly detrimental effect on overall survival for bladder cancer patients. However, there was huge heterogeneity in how a delay was defined. This review highlights the importance of scheduling radical cystectomies in a timely manner whilst monitoring factors such as comorbidities and scheduling in order treat those patients requiring radical cystectomy without delay.
