Bladder Preservation Therapy Linked With Reduced Survival in MIBC

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Radical cystectomy is associated with better survival, but findings suggest BPT may produce acceptable oncologic outcomes in appropriately selected patients.
Radical cystectomy is associated with better survival, but findings suggest BPT may produce acceptable oncologic outcomes in appropriately selected patients.

Overall survival is lower for patients with stage 2 to 3 muscle-invasive bladder cancer (MIBC) receiving bladder preservation therapy (BPT) compared with radical cystectomy (RC), a new study finds.

Of 32,300 patients from the National Cancer Data Base 2004–2013, 22,680 underwent RC and 9620 had BPT, with patients stratified as having received any external beam radiation therapy (EBRT), definitive EBRT (50–80 Gy), or definitive EBRT plus chemotherapy. In the BPT group, 2540 patients (26.4%) had definitive EBRT and 1489 patients (15.5%) had definitive EBRT with concurrent chemotherapy. Only 14% of RC patients had neoadjuvant chemotherapy.

BPT was associated with significantly reduced overall survival compared with RC, according to results published online ahead of print in Cancer. The survival advantage of RC diminished as BPT was more narrowly defined with adjustment for confounders. Multivariate analysis showed any EBRT, definitive EBRT, and definitive EBRT with chemotherapy were associated with a 2.1, 1.9, and 1.6 times increased risk of death, respectively. Using propensity score matching, the risk of death was 2.0, 1.6, and 1.4 times greater, respectively.

“There is an ongoing need to characterize survival outcomes to distinguish who can benefit from bladder-sparing approaches and avoid the morbidity of radical cystectomy,” lead author David B. Cahn, DO, MBS, a urologic oncology fellow at Fox Chase Cancer Center in Philadelphia, told Renal & Urology News. “The results of the current study suggest that BPT may produce acceptable oncologic outcomes in appropriately selected patients. Our data support a prospective randomized trial comparing trimodal bladder preservation with radical cystectomy.”

Generally, BPT candidates include those with node-negative, non-metastatic stage 2 to 3 urothelial carcinoma of the bladder, no carcinoma in situ, unifocal lesions, and no hydronephrosis, who are likely to have complete TURBT, according to the investigators. Patients with renal function decline may have limited options.

Reference

Cahn DB, Handorf EA, Ghiraldi EM, et al. 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. [Epub ahead of print]

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