Expert Commentary:Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer

Bladder preservation therapy is a definitive treatment option for clinically localized bladder cancer.  Previous studies demonstrated improved 10-year locoregional control when comparing chemo-radiotherapy with radiation therapy alone. However, evidence from prospective or randomized controlled trials comparing survival outcomes of patients treated with bladder preservation with those of patients receiving radical cystectomy is generally lacking.

A new study published in the journal Cancer addressed this question. The authors mined the National Cancer Data Base to identify patients with AJCC stage II to III urothelial carcinoma of the bladder from 2004 through 2013 and receiving either bladder preservation radical cystectomy. 

The study identified 32,300 patients meeting inclusion criteria. Of the patients treated with bladder preserving therapy, 26.4% (2540 patients) and 15.5% (1489 patients), were treated with definitive radiotherapy and chemo-radiotherapy respectively. The investigators observed a modest increase in the use of bladder preservation therapy (28.9% in 2004 to 32.3% in 2013), on the other hand, the use of radical cystectomy declined (71.1% in 2004 to 67.7% in 2013), P<.0001. Interestingly, the study showed an improvement in overall survival in patients undergoing radical cystectomy in all groups. After controlling for confounders, the overall survival associated with radical cystectomy benefit became attenuated on multivariate analysis but continued to be significant. 

While observational and retrospective, this data sheds light on an important question and highlights the need for more well-studied and more effective methods of bladder preservation to achieve the best long-term survival. Incorporating immunotherapy into this space is currently underway.

Written By: Bishoy Faltas MD

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References:
Cahn DB, Handorf EA, Ghiraldi EM, Ristau BT, Geynisman DM, Churilla TM, Horwitz EM, Sobczak ML, Chen DYT, Viterbo R, Greenberg RE, Kutikov A, Uzzo RG, Smaldone MC. Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer. Cancer. 2017 Jul 25. doi: 10.1002/cncr.30900.
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