A Nationwide Population Based Analysis of Organ-Confined Muscle-Invasive Bladder Cancer Patients Not Receiving Curative Intent Therapy in Sweden from 1997 to 2014.

While radical cystectomy remains the standard treatment for muscle-invasive bladder cancer, the natural history of patients unable or unwilling to receive curative intent therapy (CIT) is not well understood. The study objective was to identify these patients in a population-based cohort and investigate the clinical profile and describe time to mortality.

BladderBaSE, a database collected 1997-2014 was analyzed. 9 811 patients with stage T2-T4 were identified. Median overall survival (MOS), and cancer specific survival was estimated using Kaplan-Meier methods. Relative risks due to prognostic factors were estimated using Cox proportional hazards models.

5 592 patients did not receive CIT; 68% were male and 32% were female. The median ages were 79 and 81 years, respectively. After one year, patients had been hospitalized on average 18.8 days (2.1 times). Major and minor urologic surgery were the most commonly registered procedures during these hospitalizations. MOS was worse for women (7 months) than for men (8 months). Risk factors for death from bladder cancer were higher tumor stage, age >80 years, later year of diagnosis, and female gender. 1 352 (24%) patients were diagnosed with organ confined disease (T2-T3 M0). These patients had a median of 2.4 hospitalizations/patient over the first 12 months from diagnosis. Half of these hospitalizations were due to cancer or genitourinary symptoms. MOS for the organ-confined subgroup was 11 months. The majority of these had N0 stage and they had 2 month longer MOS but otherwise similar outcomes.

These patients experience a substantial disease-specific morbidity, are hospitalized frequently over their final year of life, and die primarily from bladder cancer progression.

The Journal of urology. 2019 May 30 [Epub ahead of print]

Dan-Olle Westergren, Truls Gårdmark, Lars Lindhagen, Albert Chau, Per-Uno Malmström

UROLOGKLINIKEN, AKADEMISKA SJUKHUSET , UPPSALA , SWEDEN., UROLOGKLINIKEN, DANDERYDS SJUKHUS , STOCKHOLM , SWEDEN., UPPSALA CLINICAL RESEARCH CENTER , UPPSALA , SWEDEN., DATACISION LIMITED, BUCKINGHAMSHIRE , UNITED KINGDOM., DEPARTMENT OF SURGICAL SCIENCES, UPPSALA UNIVERSITY , UPPSALA , SWEDEN.