To investigate the characteristics and outcomes of patients with muscle-invasive bladder cancer (MIBC) treated with transurethral resection (TUR) plus chemotherapy alone in a large observational cohort reflecting the continuum of practice settings in the United States.
Within the National Cancer Database (2004-2015), we identified 1,538 patients treated with TUR plus multi-agent chemotherapy as definitive treatment for cT2-T4aN0M0 urothelial carcinoma of the bladder. For comparison purposes, we included 17,866 patients treated with radical cystectomy ± perioperative chemotherapy. Baseline characteristics were compared between the 2 groups using multivariable logistic regression. Treatment outcomes were assessed using Kaplan-Meier analysis and Cox regression model.
In multivariate analysis, several variables, including patients' demography (older age, African-American race, prior malignancy, lack of insurance), tumor characteristics (higher cT stage) and facility types (non-academic facilities, lower volume of radical cystectomy) were associated with a higher probability of receiving TUR plus chemotherapy for MIBC, compared to the standard of care. The 2-year and 5-year survival rates for all patients treated with TUR plus chemotherapy were 49.0% and 32.9% and limited to patients with cT2 disease were 52.6% and 36.2%, respectively.
This large population-level cohort of unselected patients shows that long-term survival can be achieved in a subset of patients treated with TUR plus chemotherapy alone for MIBC. However, the best candidates for this approach remain to be defined. Ongoing clinical trials are now being launched to evaluate the ability of biomarkers to accurately select patients who could be treated with this bladder-sparing strategy.
The Journal of urology. 2018 Jun 04 [Epub ahead of print]
François Audenet, Nikhil Waingankar, Bart S Ferket, Scot A Niglio, Kathryn E Marqueen, John P Sfakianos, Matthew D Galsky
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: .