ABSTRACT
Objective
To address the overarching question whether chemoradiation therapy (CMT) offers overall
survival (OS) similar to that of radical cystectomy (RC) in muscle-invasive bladder
cancer (MIBC), we performed analyses using the National Cancer Database.
Materials and Methods
Patients diagnosed with MIBC in 2004-2014 who underwent RC or received primary CMT
were identified in the National Cancer Database. Survival was estimated using the weighted Kaplan-Meier method, and propensity score-weighted
Cox proportional hazards model were used to evaluate association of clinicopathologic
features with outcome.
Results
Of 484,367 patients with a diagnosis of bladder cancer, 35,856 underwent RC and 4050
received CMT. After applying the exclusion/inclusion criteria, data for 15,854 patients
who underwent RC and 2083 who received CMT were available for analysis. Five-year
OS was 40.4% in the RC group and 29.4% in the CMT group (P <.001). OS was significantly shorter in the CMT group than in the RC group in both
multivariate analysis (hazards ratio [HR] 1.15, 95% CI 1.08-1.22; P <.001) and propensity score-weighted analysis (HR 1.18, 95% CI 1.07-1.30; P <.001). Interaction terms indicated better survival after RC in patients younger
than 70 years (HR 1.61, 95% CI 1.34-1.93; P <.001); subgroup analyses identified a survival benefit in patients with N0/N1 disease
who underwent RC (HR 1.21, 95% CI 1.09-1.33; P <.001).
Conclusion and Relevance
OS after 1 year of treatment was increased in RC group compared to CMT group in patient
with MIBC. Further studies are required to identify optimal treatment for specific
patients.
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Article info
Publication history
Published online: August 08, 2019
Accepted:
May 16,
2019
Received:
December 20,
2018
Footnotes
Funding Support: This project was supported by the National Center for Advancing Translational Sciences, National Institute of Health, through grant UL1 TR 001120 to DK.
Previous Presentations: The study abstract was presented at the annual meeting of the American Urologic Association in San Francisco, CA, on May 18, 2018.
Substantial Contributions: The manuscript was copy-edited by Susan Albrecht at MedSurgBio Ltd.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
