Trimodal therapy (TMT) and radical cystectomy (RC) yield similar survival outcomes for patients with non-metastatic muscle-invasive bladder cancer, according to a new systematic review and meta-analysis.

Omar Fahmy, MRCS, of Universiti Putra Malaysia, and his team reviewed 57 studies of low to moderate quality that included 30,293 patients with muscle-invasive bladder cancer (MIBC). Overall and disease-specific survival at 10 years was 30.9% and 50.9% for TMT, respectively, and 35.1% and 57.8% for RC. The survival differences between the treatments were not statistically significant.

About 13% of TMT patients also received neoadjuvant chemotherapy (NAC). Three-quarters of all TMT patients experienced a complete response. At 5 years, overall, disease-specific, and recurrence-free survival for TMT patients were 66.9%, 78.3%, and 52.5%, respectively. The best survival outcomes after TMT occurred with complete response, the investigators noted.

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Just 3% of RC patients received NAC. Nearly a third of RC patients receiving NAC or transurethral bladder tumor resection (TURBT) were downstaged to pT1 or below. Patients with these treatments had better survival compared with those undergoing RC alone. NAC significantly increased the rate of pT0 from 20.2% to 34.3% for those with clinical T2 disease and from 3.8% to 23.9% for those with clinical T3–4. Five year overall, disease-specific, and recurrence-free survival for patients downstaged to T1 or below at RC were 75.7%, 88.3%, and 75.8%, respectively.

“The results of this study suggest that the trimodal concept of TURBT provides similar chances of long-term cure compared to RC,” Dr Fahmy and colleagues stated in Urologic Oncology. “They also suggest that downstaging should be pursued for patients who are eligible to undergo NAC.”

Among the study’s limitations, the researchers noted that data on age and comorbidities were incomplete, leaving open the possibility that some patients chose TMT because they could not tolerate surgery.

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Fahmy O, Khairul-Asri MG, Schubert T, et al. A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Onc. doi: 10.1016/j.urolonc.2017.10.002