Real-World mUCB Patient Survival Worse Than in Clinical Trials
Just 1 in 4 patients diagnosed with metastatic urothelial carcinoma of the bladder survive for a year, according to US national registry data.
|The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017.|
BOSTON — Although clinical trials report median overall survival rates of 8 to 16 months for selected patients diagnosed with metastatic urothelial carcinoma of the bladder (mUCB), few patients in real-world practice are surviving that long, investigators reported at the American Urological Association's 2017 annual meeting.
Using 2004–2012 data from the National Cancer Database, William Parker, MD, and colleagues at the Mayo Clinic in Rochester, Minnesota, determined overall survival rates for 3374 patients (median age 71 years; 70% male) diagnosed with mUCB during real-world practice in the United States. The investigators also examined overall survival by pattern of metastatic disease and treatment modality.
Results showed that mUCB patients actually had poor overall survival with only 27% surviving 1 year from diagnosis. Median overall survival was just 5.5 months.
Most patients (82%) were diagnosed with visceral metastases only; 11% had metastases to non-regional lymph nodes only; and 8% a combination. Patients with any visceral metastases had worse median overall survival: 5.0 vs 11.1 months.
The investigators found significant differences in overall survival by treatment: multimodal (12.6 months), chemotherapy (10.6 months), radiation (6.9 months), and surgery (5.4 months). Only about a third of patients received chemotherapy in accordance with guidelines.
More than half of patients received no treatment other than palliative therapy. Overall survival of these patients was 4.8 months. Patients not receiving any treatment survived just 2.0 months.
Among all groups, those who survived the longest (average 13.8 months) were patients diagnosed with metastases just to non-regional lymph nodes who were treated with chemotherapy. Only 5% of all patients were in this group. By comparison, patients with visceral metastatic disease receiving chemotherapy had a median overall survival of 9.9 months.
“Only patients with metastases to non-regional lymph nodes treated with chemotherapy experienced an overall survival similar to that reported in clinical trials,” Dr Parker said. “We should therefore interpret survival outcomes from randomized controlled trials cautiously, as few patients experience comparable survival in real-world practice.”
Parker W, Pagliaro L, and Costello B. Practice patterns and survival for patients with metastatic urothelial carcinoma of the bladder: Does real world practice parallel clinical trial outcomes? Poster presented at the American Urological Association's 2017 annual meeting on May 13, 2017. Poster MP34-02.