Within the National Cancer Database (2004-2015), the authors identified 1,538 patients who were treated with TUR + multi-agent systemic chemotherapy, without radiation, as definitive treatment for cT2-T4aN0M0 urothelial carcinoma of the bladder. Baseline characteristics were compared relative to those of 17,866 patients treated during the same period of time with radical cystectomy ± perioperative chemotherapy. Treatment outcomes were assessed using Kaplan-Meier analysis.
Compared to patients who were treated with cystectomy ± perioperative chemotherapy, patients treated with TURBT + chemotherapy alone were significantly older (≥75 years old 33.9% vs. 29.6%; p < 0.0001), had a higher clinical T stage (cT3-T4: 23.5% vs. 18.1%, p < 0.0001) and were more frequently treated in non-academic facilities (64.7% vs. 48.1%; p < 0.001). There were no significant differences between groups regarding gender, Charlson comorbidity score, and income/education level. The 30-day and 90-day mortality with TUR + chemotherapy was 0.16% and 3.76%, respectively. The 5-year survival rate for T3-T4 treated with TUR + chemotherapy was 23.3% (95% CI 18.6, 29.2), and limited to patients with cT2 disease was 36.21% (95% CI 32.9, 39.9).
This large real-world cohort representing the continuum of practice settings in the United States confirms that long-term survival is achievable in a subset of patients treated with TUR + chemotherapy alone for MIBC. Refinement of this bladder-sparing approach integrating putative predictive biomarkers of pathologic complete response is now the focus of recently initiated prospective clinical trials.
Presented by: François Audenet, Mount Sinai, New-York, USA
Co Authors: Nikhil Waingankar, Bart Ferket, Scot Anthony Niglio, Kathryn E. Marqueen, Reza Mehrazin, John Sfakianos, Matt D. Galsky; Icahn School of Medicine at Mount Sinai, New York, NY, France; Icahn School of Medicine at Mount Sinai, New York, NY; Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, New York, NY
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA