Radical Cystectomy for MIBC Offers Better Survival vs Chemoradiation
Large study reveals a significant 15% survival advantage associated with radical cystectomy vs chemoradiation therapy.
|The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. 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 2018.|
SAN FRANCISCO—Chemoradiation for muscle-invasive bladder cancer (MIBC) is associated with decreased overall survival compared with radical cystectomy, according to a large study presented at the American Urological Association 2018 annual meeting.
The stud is the largest to date looking at survival differences between radical cystectomy (RC) and chemoradiation therapy (CMT), noted lead investigator Dharam Kaushik, MD, of the University of Texas Health Science Center in San Antonio.
Using the National Cancer Data Base, he and his colleagues examined outcomes among 15,854 patients with MIBC who underwent RC with or without neoadjuvant chemotherapy and 2083 who underwent CMT, defined as receiving a regional dose of at least 50 Gy plus chemotherapy within 90 days of radiation therapy.
After a median follow-up of 25.8 months, patients in the CMT group had a significant 15% higher risk of death compared with RC-treated patients in both unweighted and propensity score weighted multivariate analyses. The 5-year survival rates were significantly greater for RC than CMT patients (40.4% vs 30%).
Dr Kaushik and his colleagues identified age, histology, and N-stage as variables with significant interaction with treatment effects. Compared with RC, CMT was associated with a significant 53% increased death risk among patients younger than 70 years. CMT was associated with a significant 17% increased risk of death compared with RC among patients with non-neuroendocrine tumors and a significant 18% increased risk of death among those with N0/N1 tumors.
Regardless of treatment, older age, T stage, and N stage were associated with an increased risk of death. Patients aged 80 years and older had a 72% greater risk of death than those aged less than 60 years, in weighted multivariate analysis. Patients with T3 or T4 cancer had a significant 32% and 85% increased risk of death, respectively, compared with those who had T2 disease; patients with N1 or N2-N3 disease had a significant 37% and 86% increased risk of death, respectively, compared with those who had N0 disease.
Kaushik D, Wang H, Jha R, et al. Chemoradiation versus radical cystectomy for muscle invasive bladder cancer: Comparative analysis of National Cancer Database with propensity score weighting. Data presented in poster format at the American Urological Association 2018 annual meeting, San Francisco, May 18–21. Abstract MP06-12.