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Data are registered from ankyrin diagnosing institutions both inside and outside the prefecture if the patient is a resident of the prefecture. The registry database is updated with population registers and death certificates. There is no overlap for the same patient for the same disease in the database. The database contains the following information: (1) personal identification code; (2) method of registry entry (registry system, population register, death certificate); (3) diagnosing institution; (4) sex; (5) date of birth; (6) date at diagnosis; (7) local-government code for the patient's home address; (8) International Classification of Diseases, 10th Revision (ICD-10) code for disease name; (9) International Classification of Diseases for Oncology, Third Edition (ICD-O-3) code for pathology; (10) initial or recurrent tumor; (11) date of death; (12) cause of death; (13) date of last follow-up; and (14) TNM classification according to the UICC TNM Classification Quisinostat research buy of Malignant Tumours 12 and pathological grade of ICD-O-3 among patients diagnosed after 2005. We obtained the data in an anonymous format, under a research agreement with Kanagawa Cancer Registry. Details of the database have been described previously 11. In brief (1) all information is gathered by well-trained tumor registrars certificated by the training program of Japanese Association of Cancer Registries, whose program is permitted by the SEER program; (2) follow-up information is automatically updated annually from population registers and death certificates; (3) pathological information is coded by ICD-O-3; and (4) previous versions of pathological codes have been transformed to the latest versions through standardized regulation consistent with changes in bladder cancer coding practice. Death Certificate Only (DCO) indicates patients who were only registered with ��bladder cancer�� according to the death certificate, with GSK 3 inhibitor no pathological information. We used a proportion of patients with DCO as an indicator of the precision of the database, with a cut-off value of 20% 5. The proportion of DCO in our study was 16.2%, indicating that the quality of our database was adequate. Study subjects The inclusion criterion was patients with bladder cancer (C67 in ICD-10) in the Kanagawa Cancer Registry. Exclusion criteria were as follows: (1) missing pathology (UC or non-UC), (2) vague pathology only identified as malignant tumor, carcinoma, or sarcoma, (3) benign tumor, (4) metastatic tumor from other sites, (5) recurrent tumor, (6) patients living outside Kanagawa Prefecture at diagnosis, (7) missing age, and (8) missing sex data. Variables Age Age at diagnosis was calculated and patients were classified as