Chemoradiation Versus Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Propensity Score-Weighted Comparative Analysis Using the National Cancer Database.

To address the overarching question whether chemoradiation therapy (CMT) offers overall survival (OS) similar to that of radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC), we performed analyses using the National Cancer Database (NCDB).

Patients diagnosed with MIBC in 2004-2014 who underwent RC or received primary CMT were identified in the NCDB. Survival was estimated using the weighted Kaplan-Meier method, and propensity score-weighted Cox proportional hazards model were used to evaluate association of clinicopathological features with outcome.

Of 484,367 patients with a diagnosis of bladder cancer, 35,856 underwent RC and 4050 received CMT. After applying the exclusion/inclusion criteria, data for 15,854 patients who underwent RC and 2083 who received CMT were available for analysis. Five-year OS was 40.4% in the RC group and 29.4% in the CMT group (p<0.001). OS was significantly shorter in the CMT group than in the RC group in both multivariate analysis (HR 1.15, 95% CI 1.08-1.22; p<0.001) and propensity score-weighted analysis (HR 1.18, 95% CI 1.07-1.30; p<0.001). Interaction terms indicated better survival after RC in patients younger than 70 years (HR 1.61, 95% CI 1.34-1.93; p<0.001); subgroup analyses identified a survival benefit in patients with N0/N1 disease who underwent RC (HR 1.21, 95% CI 1.09-1.33; p<0.001).

Overall survival after one year of treatment was increased in RC group compared to CMT group in patient with muscle-invasive bladder cancer. Further studies are required to identify optimal treatment for specific patients.

Urology. 2019 Aug 08 [Epub ahead of print]

Dharam Kaushik, Hanzhang Wang, Joel Michalek, Michael A Liss, Qianqian Liu, Richa Priya Jha, Robert S Svatek, Ahmed M Mansour

Department of Urology, University of Texas Health, San Antonio, TX. Electronic address: ., Department of Urology, University of Texas Health, San Antonio, TX., Department of Epidemiology & Biostatistics, University of Texas Health, San Antonio, TX.