EAU 2017: Comparison effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder

London, England (UroToday.com) In recent years, there has been increasing interest in trimodal therapy (TMT; transurethral resection of bladder tumors, radiotherapy and chemotherapy) for muscle invasive bladder cancer (MIBC) given the inherent morbidity associated with radical cystectomy. TMT is typically reserved for patients without multifocal disease and/or carcinoma in situ. Dr. Seisen and colleagues presented their population-based study this afternoon at the EAU 2017’s “Best Perioperative Outcomes from Cystectomy” poster session.

Using the US National Cancer Data Base (NCDB) from 2004-2011, the authors identified 12,843 patients with cN0M0 bladder cancer that received TMT (n=1,257, 9.8%) or radical cystectomy (n=11,586, 90.2%). The primary outcome was overall survival (OS). There was no difference in median OS using Kaplan Meier analysis between the two groups (TMT 39.6 months vs 43.0 months, p=0.29), however on adjusted Cox regression analysis using a time varying covariate (at 25 months), TMT had a significant adverse effect on OS (HR 1.37; 95%CI 1.16-1.59). On further sub-group analysis, there were no differences between TMT and radical cystectomy with regards to patients ≥70 years of age (HR 1.21; 95%CI 0.83-1.60), female gender (HR 1.28; 95%CI 0.83-1.74), Charlson comorbidity index ≥1 (HR 1.10; 95%CI 0.83-1.38) or ≥cT3 disease (HR 1.16; 95%CI 0.80-1.52). The main limitation of this study is inherent to the NCDB, including lack of disease-specific outcomes.

Since previous TMT vs radical cystectomy studies are largely institutional experiences, this study provides population-level conclusions to be drawn from the robust analyses performed by the authors. At this time, TMT appears to be safe from an oncologic standpoint (particularly in elderly and comorbid populations), however the jury is still out on whether TMT should be widely adopted among MIBC patients.

Presented by: Thomas Seisen, Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

Co-Authors: M. Sun, S. Lipsitz, F. Abdollah, J. Leow, M. Menon, N. Von Landenberg, P. Gild, M. Roupret, M. Preston, L. Harshman, A.S. Kibel, P. Nguyen, J. Bellmunt, T. Chouieri, Q.D. Trinh

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md

at the #EAU17 -March 24-28, 2017- London, England
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