Contemporary Survival Rates for Muscle-Invasive Bladder Cancer Treated With Definitive or Non-Definitive Therapy

Philipp Gild; David-Dan Nguyen; Sean A Fletcher; Alexander P Cole; Stuart R Lipsitz; Adam S Kibel; Margit Fisch; Mark A Preston; Quoc-Dien Trinh

doi:10.1016/j.clgc.2019.01.009

Contemporary Survival Rates for Muscle-Invasive Bladder Cancer Treated With Definitive or Non-Definitive Therapy

Clin Genitourin Cancer. 2019 Jun;17(3):e488-e493. doi: 10.1016/j.clgc.2019.01.009. Epub 2019 Jan 29.

Authors

Philipp Gild¹, David-Dan Nguyen², Sean A Fletcher³, Alexander P Cole³, Stuart R Lipsitz³, Adam S Kibel³, Margit Fisch⁴, Mark A Preston³, Quoc-Dien Trinh⁵

Affiliations

¹ Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
³ Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁴ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: qtrinh@bwh.harvard.edu.

PMID: 30837209
DOI: 10.1016/j.clgc.2019.01.009

Abstract

Introduction: Definitive, curatively intended therapy for muscle-invasive bladder cancer can be associated with significant morbidity and adverse effects on quality of life, leaving patients reluctant to opt for these interventions. We sought to provide perspective to patients and clinicians exploring therapy options.

Materials and methods: We examined stage-by-stage overall survival of definitive therapy (DT) (either radical cystectomy in conjunction with neoadjuvant chemotherapy or trimodal therapy) versus non-DT (including palliative transurethral resection, chemotherapy and radiation treatment) among 42,144 patients within the National Cancer Database (2004-2012).

Results: The median overall survival stratified by receipt of DT versus non-DT was 45.3 versus 16.4 months, 26.7 versus 9.6 months, and 21.2 versus 7.5 months in American Joint Committee on Cancer stages II, III, and IV, respectively. In multivariable Cox regression analysis, DT conferred a significant survival benefit in all stages, most pronounced in American Joint Committee on Cancer stage IV (hazard ratio, 0.46; 95% confidence interval, 0.43-0.49; P < .001).

Conclusion: Despite potentially significant morbidity and adverse effects on quality of life, DT is associated with a sizable survival benefit.

Keywords: Comparative effectiveness; Cystectomy; Drug therapy; Radiotherapy; Urinary bladder neoplasms.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Combined Modality Therapy
Cystectomy / mortality*
Female
Follow-Up Studies
Humans
Male
Muscle Neoplasms / mortality*
Muscle Neoplasms / pathology
Muscle Neoplasms / therapy
Neoadjuvant Therapy / mortality*
Neoplasm Staging
Survival Rate
Urinary Bladder Neoplasms / mortality*
Urinary Bladder Neoplasms / pathology
Urinary Bladder Neoplasms / therapy