Cytoreductive RC Aids Survival of Metastatic Bladder Cancer Patients

Patients who underwent debulking had significantly longer overall survival compared with those who did not (median 15.7 vs 10 months).
Patients who underwent debulking had significantly longer overall survival compared with those who did not (median 15.7 vs 10 months).

SAN DIEGO—Cytoreductive radical cystectomy may be beneficial for select patients with metastatic urothelial carcinoma of the bladder, according to a new study presented at the American Urological Association's annual meeting.

Francisco Gelpi-Hammerschmidt, MD, and colleagues of Brigham and Women's Hospital in Boston compared oncologic outcomes of patients with M1 disease. Using the National Cancer Data Base 1998-2012, they identified 4,233 patients who received multi-agent systemic chemotherapy. Of these, 3,953 had conventional treatments (endoscopic resection, radiotherapy, or a combination) and 280 received a cytoreductive radical cystectomy (cyto-RC).

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Results showed a survival benefit for cyto-RC. Median overall survival was significantly longer in the cyto-RC group (15.7 vs 10 months). A multivariable Cox regression model further showed that cyto-RC was associated with a significant survival benefit by 41% compared with the other modalities. Adjustments were made for relevant patient and institutional factors such as comorbidities, clinical T stage, and treatment center type.

The investigators also examined perioperative outcomes. Using the Premier Hospital Database 2003–2013, they identified 1,888 cyto-RC cases. Slightly more cyto-RC patients than conventional radical cystectomy patients had complications at 90 days (59.5% vs 58%). Their mortality rates were also higher (4.2% vs 3.0%). The investigators found no differences between groups in major complications, length of hospital stay, or blood transfusions.

“While the outcomes for metastatic urothelial carcinoma of the bladder are poor, our study suggests an overall survival benefit associated with patients who underwent a cytoreductive cystectomy,” Dr Gelpi-Hammerschmidt stated. “Nevertheless, this benefit might be coupled with modestly worse surgical morbidity and mortality, suggesting these procedures should be reserved for carefully selected patients or as part of a clinical trial.” 

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