Introduction
Patients and methods
Study design, cohort selection, and data acquisition
-
RAMQ, which collects all public medical and pharmaceutical services provided to patients in the province;
-
ISQ, which collects death statistics on Québec inhabitants;
-
MED-ÉCHO, which collects data on hospitalization of patients in public hospitals in the province.
Outcome parameters
Statistical analyses
Results
All patients | NSAID use | Metformin use | Prednisone use | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Preoperative chronic use | No | P-value | Preoperative chronic use | No | P-value | Preoperative chronic use | No | P-value | ||
Number of patients | 3742 | 1503 | 1025 | 420 | 3052 | 293 | 2363 | |||
Age, median (IQR) | 70 (64–76) | 72 (67–77) | 69 (62–75) |
< 0.001
| 72 (67–76) | 70 (63–76) |
< 0.001
| 72 (67–76) | 70 (63–76) |
< 0.001
|
Sex | ||||||||||
- Male | 2827 (75.5%) | 1167 (77.6%) | 746 (72.8%) |
0.005
| 334 (79.5%) | 2278 (74.6%) |
0.030
| 203 (69.3%) | 1829 (77.4%) |
0.002
|
- Female | 915 (24.5%) | 336 (22.4%) | 279 (27.2%) | 86 (20.5%) | 774 (25.4%) | 90 (30.7%) | 534 (22.6%) | |||
Region of residence | ||||||||||
- Regions with cities with > 400,000 inhabitants | 1453 (38.8%) | 555 (36.9%) | 434 (42.3%) |
0.008
| 164 (39.0%) | 1187 (38.9%) | 0.95 | 99 (33.8%) | 936 (39.6%) | 0.14 |
- Regions with cities with 100,000-250,000 inhabitants | 2012 (53.8%) | 839 (55.8%) | 524 (51.1%) | 228 (54.3%) | 1641 (53.8%) | 173 (59.0%) | 1258 (53.2%) | |||
- Rural regions (largest city in region < 100,000 inhabitants) | 252 (6.7%) | 106 (7.1%) | 55 (5.4%) | 26 (6.2%) | 201 (6.6%) | 20 (6.8%) | 150 (6.3%) | |||
- Unknown | 25 (0.7%) | 3 (0.2%) | 12 (1.2%) | 2 (0.5%) | 23 (0.8%) | 1 (0.3%) | 19 (0.8%) | |||
Charlson’s comorbidity index, median (IQR) | 7 (5–8) | 7 (6–9) | 6 (5–7) |
< 0.001
| 8 (7–10) | 6 (5–8) |
< 0.001
| 8 (6–9) | 6 (5–8) |
< 0.001
|
Year of surgery | ||||||||||
- 2000–2009 | 2203 (58.9%) | 839 (55.8%) | 561 (54.7%) | 0.59 | 189 (45.0%) | 1835 (60.1%) |
< 0.001
| 169 (57.7%) | 1308 (55.4%) | 0.45 |
- 2010–2015 | 1539 (41.1%) | 664 (44.2%) | 464 (45.3%) | 231 (55.0%) | 1217 (39.9%) | 124 (42.3%) | 1055 (44.6%) | |||
Hospital characteristics | ||||||||||
- Distance to hospital in km, median (IQR) | 20 (7–77) | 20 (7–85) | 17 (7–57) |
0.020
| 20 (8–67) | 19 (7–71) | 0.74 | 26 (10–80) | 19 (7–76) |
0.048
|
- Hospital type, academic | 1886 (50.4%) | 729 (48.5%) | 534 (52.1%) | 0.08 | 197 (46.9%) | 1559 (51.1%) | 0.11 | 149 (50.9%) | 1208 (51.1%) | 0.93 |
- Hospital RC volume/year, median (IQR) | 13 (8–32) | 13 (7–32) | 13 (7–32) | 0.90 | 13 (7–32) | 13 (8–32) | 0.32 | 13 (8–32) | 13 (8–32) | 0.71 |
- Surgeon RC volume/year, median (IQR) | 7 (5–13) | 7 (5–13) | 8 (5–13) | 0.61 | 7 (5–10) | 7 (5–13) | 0.43 | 7 (5–13) | 7 (5–13) | 0.77 |
Type of bladder diversion | ||||||||||
- Ileal conduit | 3046 (81.4%) | 1269 (84.4%) | 830 (81.0%) |
0.012
| 371 (88.3%) | 2465 (80.8%) |
0.001
| 248 (84.6%) | 1896 (80.2%) | 0.12 |
- Continent diversion | 544 (14.5%) | 176 (11.7%) | 155 (15.1%) | 38 (9.0%) | 456 (14.9%) | 37 (12.6%) | 376 (15.9%) | |||
- Unknown | 152 (4.1%) | 58 (3.9%) | 40 (3.9%) | 11 (2.6%) | 131 (4.3%) | 8 (2.7%) | 91 (3.9%) | |||
Neoadjuvant chemotherapy | 208 (5.6%) | 74 (4.9%) | 76 (7.4%) |
0.009
| 23 (5.5%) | 170 (5.6%) | 0.94 | 8 (2.7%) | 154 (6.5%) |
0.011
|
Preoperative chronic medication use | ||||||||||
- Statins | 1406 (37.6%) | 939 (62.5%) | 206 (20.1%) |
< 0.001
| 308 (73.3%) | 1001 (32.8%) |
< 0.001
| 142 (48.5%) | 826 (35.0%) |
< 0.001
|
- NSAIDs | 1503 (40.2%) | - | - | - | 284 (67.6%) | 1128 (37.0%) |
< 0.001
| 159 (54.3%) | 864 (36.6%) |
< 0.001
|
- Aspirin | 1144 (30.6%) | 1144 (76.1%) | - | - | 257 (61.2%) | 814 (26.7%) |
< 0.001
| 116 (39.6%) | 652 (27.6%) |
< 0.001
|
- Other NSAIDs | 464 (12.4%) | 464 (30.9%) | - | - | 56 (13.3%) | 382 (12.5%) |
< 0.001
| 60 (20.5%) | 249 (10.5%) |
< 0.001
|
- Metformin | 420 (11.2%) | 284 (18.9%) | 61 (6.0%) |
< 0.001
| - | - | - | 32 (10.9%) | 259 (11.0%) | 1.00 |
- Prednisone | 293 (7.8%) | 159 (10.6%) | 57 (5.6%) |
< 0.001
| 32 (7.6%) | 242 (7.9%) | 0.58 | - | - | - |
Follow-up time (in years), median (95% CI) | 7.9 (7.6–8.4) | 7.3 (6.7–7.7) | 6.5 (5.6–7.4) | 5.4 (4.7–6.4) | 8.1 (7.7–8.5) | 8.2 (7.2–8.9) | 6.6 (6.3–7.2) |
Overall survival | Bladder cancer-specific survival | Recurrence-free survival | ||||
---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | Univariable | Multivariable | |
Preoperative chronic medication use | ||||||
- Statins |
0.86
(0.79–0.94)
|
0.80
(0.69–0.93)
|
0.79
(0.71–0.88)
|
0.72
(0.60–0.86)
|
0.80
(0.72–0.89)
|
0.73
(0.62–0.88)
|
- NSAIDs | 0.95 (0.86–1.05) | 1.10 (0.95–1.27) | 0.93 (0.82–1.05) |
1.24
(1.03–1.48)
| 0.94 (0.84–1.06) |
1.22
(1.03–1.45)
|
- Metformin |
1.21
(1.07–1.38)
|
1.29
(1.07–1.55)
|
1.20
(1.03–1.40)
|
1.38
(1.10–1.72)
|
1.24
(1.07–1.44)
|
1.41
(1.13–1.74)
|
- Prednisone |
0.74
(0.63–0.86)
|
0.67
(0.55–0.82)
|
0.59
(0.48–0.72)
|
0.58
(0.45–0.76)
|
0.64
(0.53–0.77)
|
0.61
(0.47–0.78)
|
Age, per 5-year increment |
1.22
(1.19–1.25)
|
1.21
(1.15–1.27)
|
1.16
(1.13–1.20)
|
1.19
(1.12–1.26)
|
1.12
(1.09–1.15)
|
1.13
(1.07–1.19)
|
Female sex (ref: male sex) | 0.96 (0.88–1.06) | 0.91 (0.78–1.06) | 1.01 (0.90–1.13) | 0.85 (0.71–1.03) | 1.04 (0.93–1.16) | 0.87 (0.73–1.04) |
Region of residence (ref: Regions with cities with > 400,000 inhabitants) | ||||||
- Regions with cities with 100,000-250,000 inhabitants | 0.96 (0.89–1.05) | 0.94 (0.81–1.09) | 0.93 (0.873–1.03) | 0.90 (0.75–1.08) |
0.90
(0.82–0.99)
|
0.84
(0.70-1.00)
|
- Rural regions (largest city in region < 100,000 inhabitants) | 0.94 (0.80–1.12) | 1.18 (0.78–1.79) | 0.96 (0.78–1.18) | 1.23 (0.76–2.01) | 0.91 (0.75–1.11) | 1.00 (0.62–1.62) |
Charlson’s comorbidity index, per 1 increment |
1.02
(1.01–1.04)
|
0.96
(0.93-1.00)
|
0.98
(0.96-1.00)
|
0.93
(0.88–0.97)
|
0.97
(0.95–0.99)
|
0.93
(0.89–0.98)
|
Year of surgery, 2010–2015 (ref: 2000–2009) | 1.02 (0.93–1.12) |
0.69
(0.60–0.80)
| 1.03 (0.92–1.14) |
0.67
(0.57–0.80)
| 1.05 (0.95–1.16) |
0.70
(0.60–0.83)
|
Hospital characteristics | ||||||
- Distance to hospital in km, per 50 km increment | 1.00 (0.99–1.02) | 1.00 (0.96–1.04) | 1.01 (0.99–1.03) | 1.00 (0.95–1.05) | 1.01 (0.99–1.02) | 1.01 (0.96–1.06) |
- Academic hospital (ref: non-academic hospital) |
0.90
(0.83–0.97)
| 0.94 (0.78–1.13) | 0.93 (0.85–1.03) | 0.95 (0.75–1.19) | 0.96 (0.87–1.05) | 1.00 (0.80–1.24) |
- Hospital RC volume, per 5/year increment | 0.99 (0.98-1.00) | 1.00 (0.96–1.04) | 0.99 (0.98–1.01) | 1.01 (0.96–1.06) | 1.00 (0.98–1.01) | 1.21 (0.96–1.05) |
- Surgeon RC volume, per 5/year increment |
0.95
(0.92–0.99)
| 0.98 (0.88–1.09) | 0.97 (0.93–1.01) | 0.98 (0.86–1.11) | 0.98 (0.94–1.02) | 0.97 (0.86–1.10) |
Continent bladder diversion (ref: ileal conduit) |
0.50
(0.44–0.58)
|
0.58
(0.46–0.73)
|
0.57
(0.49–0.67)
|
0.61
(0.47–0.80)
|
0.62
(0.53–0.72)
|
0.62
(0.48–0.79)
|
Neoadjuvant chemotherapy | 0.94 (0.77–1.15) | 1.17 (0.87–1.58) | 1.15 (0.92–1.44) | 1.38 (1.00-1.91) | 1.18 (0.96–1.46) | 1.30 (0.95–1.78) |
Overall survival | Bladder cancer-specific survival | Recurrence-free survival | ||||
---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | Univariable | Multivariable | |
Postoperative medication use | ||||||
- Statins | 0.90 (0.80–1.01) |
0.76
(0.63–0.91)
|
0.79
(0.69–0.91)
|
0.65
(0.53–0.81)
|
0.82
(0.72–0.93)
|
0.69
(0.56–0.84)
|
- NSAIDs |
1.14
(1.00-1.30)
|
1.34
(1.11–1.61)
| 1.08 (0.92–1.27) |
1.46
(1.18–1.82)
| 1.12 (0.96–1.30) |
1.47
(1.20–1.80)
|
- Aspirin |
1.16
(1.03–1.30)
| 1.16 (0.96–1.41) | 0.98 (0.85–1.14) | 1.18 (0.94–1.48) | 0.91 (0.80–1.04) | 1.05 (0.85–1.30) |
- Other NSAIDs | 1.13 (0.99–1.29) |
1.25
(1.05–1.49)
|
1.24
(1.06–1.46)
|
1.49
(1.22–1.82)
|
1.40
(1.21–1.63)
|
1.55
(1.29–1.87)
|
- Metformin | 1.16 (0.98–1.38) | 1.18 (0.93–1.50) | 1.19 (0.97–1.46) | 1.32 (0.99–1.75) |
1.25
(1.04–1.51)
|
1.31
(1.01–1.70)
|
- Prednisone | 1.07 (0.92–1.23) | 0.85 (0.70–1.03) | 0.93 (0.77–1.11) | 0.87 (0.69–1.09) | 0.96 (0.81–1.13) | 0.87 (0.71–1.08) |