(UroToday.com) Prior randomized controlled trials comparing bladder preservation to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) closed due to lack of accrual. None are foreseen in the near future. Thus, we aimed to compare trimodality therapy (TMT, maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to radical cystectomy (RC) in matched cohorts of patients with MIBC.
This retrospective analysis included 703 patients with MIBC clinical stage T2- T3N0M0 MIBC urothelial carcinoma of the bladder (421RC/282TMT) who would have been eligible for both RC and TMT. Patients were treated at three university centers between 2005-2017. All patients had solitary tumors <7cm, no or unilateral hydronephrosis, and no extensive carcinoma in situ. Treatment propensity scores were estimated using logistic regression and patients were matched 3:1 with replacement. Adjusted Cox models and adjusted competing risk models were used with metastasis-free survival as primary endpoint.
A total of 1,116 patients (834 RC vs 282 TMT) was included in the matched cohort. After matching, age (71.3vs71.6), cT2 stage (88vs90%), presence of hydronephrosis (12vs10%), and use of (neo)adjuvant chemotherapy (60vs65%) were similar between RC and TMT. Salvage cystectomy was performed in 38(13%) patients treated by TMT. At 5 years, metastasis-free survival (73vs78%, p=0.07) was not statistically different between RC and TMT. Outcomes for RC and TMT were not different among centers. Pathological stage in the 421 RC was pT2 in 29%, pT3-4 in 42% and 24% node positive.
In conclusion, our multi-institutional contemporary study provides the best evidence to date demonstrating similar oncologic outcomes between RC and TMT for select MIBC patients.
Presented by: Alexandre Zlotta, University of Toronto, Toronto, ON, Canada
Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the International Bladder Cancer Network Annual Meeting, September 28-October 1, 2022, Barcelona, Spain