Patients with clinically node-positive bladder cancer were historically considered to have uniformly poor prognosis and were frequently treated with palliative chemotherapy (CHT) only. Although retrospective data show that long-term survival with combined treatment (surgery + CHT) is possible in one-third of these patients, consensus on a treatment algorithm is still lacking. The aim of the study is to compare the efficacy of different treatment modalities based on data from a population-based cancer registry.
The study comprises 661 patients identified from the Czech National Cancer Registry (1996-2015) with cTanyN1-3M0 bladder cancer; 195 were treated with CHT alone, 234 underwent radical cystectomy alone (RC), and 232 received a combination of RC and perioperative CHT (RC + CHT). Multivariate Cox proportional hazard regression analyses were used to evaluate the effectiveness of various treatments.
The 5-year OS for CHT alone, RC alone, and RC + CHT were 21.7% (95% confidence interval [CI], 15.4%-28.0%), 12.1% (95% CI, 7.4%-16.7%), and 25.4% (95% CI, 18.9%-31.9%), respectively (P < .001). The median survivals were 17, 10, and 23 months, respectively. In multivariate analysis, age > 60 years (hazard ratio, 1.29; 95% CI, 1.06-1.56; P = .011) and clinical stage cT3-4 (hazard ratio, 1.39; 95% CI, 1.12-1.71; P = .002) were negative predictors of survival. When compared with CHT, RC + CHT reduced the risk of overall mortality by 21% (P = .044).
Approximately one-quarter of clinically node-positive patients may achieve long-term survival with combined treatment integrating RC and perioperative CHT. The overall survival of patients is significantly improved with a multimodal approach in comparison to CHT alone.
Clinical genitourinary cancer. 2019 Apr 16 [Epub ahead of print]
Michal Staník, Alexandr Poprach, Michaela Zapletalová, Denisa Krejčí, Daniel Macík, Ivo Čapák, Jiří Jarkovský, Radek Lakomý, Jan Doležel
Department of Urologic Oncology, Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic. Electronic address: ., Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic., Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic., Department of Urologic Oncology, Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.