Comparison of Outcomes in Patients With Muscle-Invasive Bladder Cancer Treated With Radical Cystectomy Versus Bladder-Preserving Chemoradiation

• Type of Material: Article
• Authors: Jim Zhong, Emory University; Jeffrey Switchenko, Emory University; Naresh K. Jegadeesh, Emory University; Richard J. Cassidy, Emory University; Theresa Gillespie, Emory University; Viraj Master, Emory University; Mehrdad Alemozaffar, Emory University; Peter Nieh, Emory University; Omer Kucuk, Emory University; Bradley Carthon, Emory University; Christopher Filson, Emory University; Mehmet Asim Bilen, Emory University; Ashesh Jani, Emory University
• Language: English
• Date: 2016-10-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2021 Wolters Kluwer Health, Inc. and/or its subsidiaries. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijrobp.2016.06.234
• Title of Journal or Parent Work: American Journal of Clinical Oncology
• Volume: 96
• Issue: 2
• Start Page: S93
• End Page: S94
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Science & Technology; Radiology, Nuclear Medicine & Medical Imaging; Oncology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Oncology

Abstract

Purpose Radical cystectomy currently remains the standard of care for muscle-invasive bladder cancer (MIBC). However, surgery can be associated with considerable morbidity and mortality, including the removal of the bladder. An alternative strategy is to preserve the bladder through concurrent chemo-radiation following a maximal trans-urethral resection of the tumor. National protocols using a bladder preservation approach have demonstrated disease-specific outcomes comparable to radical cystectomy in selected patients, but these results have not been replicated in previously reported population-based series. Here, we describe an outcomes analysis of patients with MIBC treated with either radical surgery or bladder-preserving chemo-radiation (BPCRT) for those patients meeting BPCRT criterion using the National Cancer Database (NCDB). Methods and Materials Using the NCDB, patients with AJCC clinical T2-3, N0, M0 urothelial carcinoma diagnosed between 2004–2013 were included for analysis. Only patients treated with definitive intent with either radical cystectomy or concurrent chemotherapy and radiation after a maximal transurethral tumor resection were included. Propensity-score matching was employed. Results Among 8,454 eligible patients, 7,276 (86%) underwent radical cystectomy, and 1,178 (14%) underwent BPCRT. Patients undergoing BPCRT were significantly older (median age 77 vs 68, p <0.001) and had higher Charlson-Deyo comorbidity scores (p=0.002). Using propensity-matched analysis, 1,002 patients remained in each cohort, and there was no significant difference in survival found between the two cohorts (median OS: 2.7 vs 3.0 (p=0.20); 4-year OS: 39.1% and 42.6% (p=0.15), for BPCRT and surgery, respectively). Additionally, the hazard ratio (HR) of surgery versus BPCRT decreased over time, with an initial HR of 1.27 favoring BPCRT which decreased by a factor of 0.85 per year. Conclusions From 2004–2013, approximately 14% of patients from the NCDB who potentially met bladder preservation criteria underwent the procedure. Our propensity-matched analysis is the only report of its kind to demonstrate similar survival outcomes with bladder preservation when patients are properly selected. This study is also the first to demonstrate a dynamic hazard ratio between radical surgery and BPCRT over time. Keywords: MIBC, trimodality therapy, bladder preservation therapy, bladder cancer