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.


Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.