National Practice Patterns and Outcomes for T4b Urothelial Cancer of the Bladder: Beyond the Abstract

Clinical T4b bladder cancer, which is defined as disease that is invading the abdominopelvic wall, has historically been considered unresectable and is associated with a poor prognosis1.  The current National Comprehenisive Cancer Network (NCCN) guidelines recommend either chemotherapy (CT) or chemoradiation (CRT) for this patient population2.  The purpose of the present study was to determine current practice patterns for cT4b bladder cancer, as well as to compare clinical outcomes for different management options for this disease.  

This study was conducted using the large, contemporary dataset of the National Cancer Data Base (NCDB) and included patients diagnosed with cT4bN0-3M0 bladder cancer with complete treatment records. Patients were divided into 5 treatment groups: CT alone, CRT, radical cystectomy (RC) (with/without CT/RT), other treatment (subtherapeutic RT with/without CT), or no treatment. 

Of 896 total patients, 185 (20.6%) underwent CT alone, 80 (8.9%) CRT, 161 (18.9%) RC, 221 (24.7%) other treatments, and 249 (27.8%) observation. Observation yielded a median overall survival (OS) of 3.7 months, lower than CT alone (p<0.001). As compared to the latter, CRT was associated with higher OS (10.5 vs. 12.1 months, p=0.004). Radical cystectomy (RC)-based treatment displayed the numerically highest OS (14.2 months) and was statistically similar to CRT (p=0.676). Treatment with any modality independently predicted for superior OS over observation.

Written by: Waqar Haque, Vivek Verma, E Brian Butler, Bin S Teh

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1 Liberman D, Alasker A, Sun M, et al. Radical cystectomy for patients with pT4 urothelial carcinoma in a large population-based study. BJU Int 2011;107:905-911.

2 National Comprehensive Cancer Network. Bladder cancer. Version 4.2017. Accessed May 19, 2017.