Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle invasive bladder cancer

To compare survival outcome between chemoradiation and radical cystectomy for Muscle invasive bladder cancer(MIBC).

A retrospective analysis was performed using muscle-invasive bladder cancer (≥cT2, N0, M0) patients in the National Cancer Database (2004-2013). Chemoradiation was defined as radiation dose ≥40Gy and chemotherapy within 90d of radiation. Descriptive statistics were used to compare groups. Radical cystectomy and chemoradiation patients were propensity matched. Kaplan Meier analysis was used to compare overall survival. Multivariable Cox regression was used to determine predictors of survival.

8,379 (6,606 cystectomy and 1,773 chemoradiation) patients met criteria. 1,683 patients in each group were propensity matched. On multivariable extended Cox analysis, significant predictors of decreased OS were age, Charlson score 1, Charlson score 2, stage cT3-4, and urothelial histology. Treatment with chemoradiation was associated with decreased mortality at year 1 (HR 0.84; CI [0.74 - 0.96] p=0.01) but, at year 2 (HR 1.4; CI [1.2-1.6], p<0.0001) and years 3 onward (HR 1.5; CI [1.2-1.8], p = 0.0002), chemoradiation was associated with increased mortality. 5-year overall survival was higher for radical cystectomy versus chemoradiation (38% vs 30%, p=0.004).

Initially following treatment for muscle invasive bladder cancer, risk of mortality is lower with chemoradiation compared to radical cystectomy. However, at ≥2 years following treatment mortality risk favors radical cystectomy. Patients who are suitable surgical candidates, with low risk of morbidity, may be better served with radical cystectomy. This article is protected by copyright. All rights reserved.

BJU international. 2017 Dec 27 [Epub ahead of print]

Chad R Ritch, Raymond Balise, Nachiketh Soodana Prakash, David Alonzo, Katherine Almengo, Mahmoud Alameddine, Vivek Venkatramani, Sanoj Punnen, Dipen Parekh, Mark L Gonzalgo

Department of Urology, University of Miami Leonard M. Miller School of Medicine, Miami, FL., Division of Biostatistics Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL.