Washington, DC (UroToday.com): David Cahn and the group from Einstein Healthcare Network and Fox Chase Cancer Center presented on the utilization trends and survival outcomes of patients undergoing radical cystectomy (RC) or bladder preservation therapy (BPT) using National Cancer Database (NCDB).
The group conducted a retrospective, observational cohort study using NCDB to identify patients with analytic stage II-III N0/M0 urothelial bladder cancer from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) 50-80 Gy, and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. Overall survival was compared between RC and BPT using Kaplan Meier curves and Cox regression models were adjusted for year of treatment, hospital volume, patient/tumor clinicopathologic variables.
Of the 603,298 patients with bladder cancer captured in the NCDB, 9% (n=54,518) had analytic stage II-III with urothelial histology. 51.1% (n=27,843) of these patients were treated with RC (70.9%, n=19,745) or BPT (29.1%, n= 8,098). Of the patientsundergoing BPT, 26.9% (n=2,176) and 15.0% (n=1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively.
Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, attenuated
differences in OS were seen using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29]; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68]).
The group concludes that the receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases.
However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to
compare trimodal BPT to RC to identify optimal candidates for bladder preservation.
Dr. David Cahn, MD
Mohammed Haseebuddin, MD. from the Society of Urologic Oncology Meeting - December 2 - 4, 2015 – Washington, DC.
Fox Chase Cancer Center, Philadelphia, PA.