Treatment Related to Urinary Tract Infections Is Associated with Delayed Diagnosis of Urinary Bladder Cancer: A Nationwide Population-based Study

Fredrik Liedberg; Truls Gårdmark; Oskar Hagberg; Firas Aljabery; Viveka Ströck; Abolfazl Hosseini; Per-Uno Malmström; Karin Söderkvist; Anders Ullén; Tomas Jerlström; Staffan Jahnson; Lars Holmberg; Christel Häggström

doi:10.1016/j.euo.2024.07.008

Treatment Related to Urinary Tract Infections Is Associated with Delayed Diagnosis of Urinary Bladder Cancer: A Nationwide Population-based Study

Eur Urol Oncol. 2024 Aug 13:S2588-9311(24)00181-0. doi: 10.1016/j.euo.2024.07.008. Online ahead of print.

Authors

Affiliations

¹ Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
² Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
³ Department of Translational Medicine, Lund University, Malmö, Sweden.
⁴ Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
⁵ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁶ Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
⁷ Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
⁸ Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden.
⁹ Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Karolinska University Hospital, Stockholm, Sweden.
¹⁰ Department of Urology, School of Medical Sciences, Örebro University, Örebro, Sweden.
¹¹ Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
¹² Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Northern Registry Centre, Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden. Electronic address: christel.haggstrom@umu.se.

PMID: 39143001
DOI: 10.1016/j.euo.2024.07.008

Abstract

Background and objective: It has been suggested that urinary tract infections (UTIs) are associated with delayed diagnosis of bladder cancer (BC). Our aim was to investigate prediagnostic treatments related to UTI and the relation to BC diagnostic delay, reflected by advanced disease at diagnosis.

Methods: We used data from the BladderBaSe 2.0 with data of treatments related to UTI up to 3 yr before BC diagnosis (2008-2019) for BC patients in comparison to a matched reference population. We investigated the association between UTI treatments and more advanced disease at diagnosis in the BC cohort. We used generalized ordered logistic regression to calculate odds ratios (ORs) for more advanced disease as an ordered outcome: non-muscle-invasive BC (NMIBC), muscle-invasive BC (MIBC), and metastatic BC (MBC).

Key findings and limitations: The study population included 29 921 BC patients and 149 467 matched reference subjects. The proportions of individuals receiving UTI treatment were higher in the patient groups than in the corresponding reference groups, with the greatest differences observed for the MIBC and MBC subgroups. The OR for the risk of more advanced disease (MIBC or MBC) with at least one UTI treatment versus none was 1.28 (95% confidence interval [CI] 1.19-1.37) for men and 1.42 (95 % CI 1.27-1.58) for women. The association to risk of more advanced disease increased with the number of UTI treatments for both sexes.

Conclusions and clinical implications: Further studies on the effects of treatments related to UTI in combination with other factors are needed to identify reasons for possible delays in the BC diagnostic pathway.

Patient summary: We found that for patients with bladder cancer, previous antibiotic treatment for a urinary tract infection was linked to more advanced disease at diagnosis. Further studies are needed to identify reasons for possible delays in the diagnosis of bladder cancer.

Keywords: Bladder cancer; Diagnostic delay; Register-based study; Urinary tract infection.