Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder
Seisen T, Sun M, Lipsitz S, Abdollah F, Leow J, Menon M, Von Landenberg N, Gild P, Rouprêt M, Preston M, Harshman L, Kibel AS, Nguyen P, Bellmunt J, Choueiri T, and Trinh QD. Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder. Eur Urol, Supplements 2017; 16(3):e476-e478.
Eur Urol Supplements
INTRODUCTION & OBJECTIVES: The only randomized controlled trial comparing trimodal therapy (TMT) vs. radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB) failed to meet its accrual target. We sought to examine the comparative effectiveness of TMT vs. RC for muscle-invasive UCB in an observational cohort study. MATERIAL & METHODS: Within the National Cancer Data Base (2004-2011), we identified 12,843 individuals who received TMT or RC for definitive treatment of cN0M0 muscle-invasive UCB. Inverse probability of treatment weighting (IPTW) adjusted Kaplan-Meier and Cox regression analyses with timevarying covariate were used to compare overall survival (OS) of patients who received TMT vs. RC. Exploratory analyses according to patient characteristics were also performed. RESULTS: Overall, 1,257 (9.8%) and 11,586 (90.2%) patients received TMT and RC, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was similar between TMT and RC groups (39.6 [95% CI, 33.7-45.5] vs. 43.0 [95% CI, 40.9-45.1] months; P=0.290; Figure 1). In IPTW-adjusted Cox regression analysis with time-varying covariate, TMT was associated with a significant adverse effect on OS after 25 months of follow-up (HR=1.37;95%CI=[1.16-1.59];P<0.001). In exploratory analyses (Figure 2), there was no significant difference between TMT and RC with regard to long-term OS in individuals aged ≥70 (HR=1.21;95%CI=[0.83-1.60];P=0.225), of female gender (HR=1.28;95%CI=[0.83-1.74];P=0.170), with Charlson comorbidity index≥1 (HR=1.10;95%CI=[0.83-1.38];P=0.439) and/or ≥cT3 disease (HR=1.16; 95%CI=[0.80-1.52];P=0.338). CONCLUSIONS: We generally observed that TMT was associated with worse long-term OS compared to RC for muscle-invasive UCB. However, selected subgroups of patients may choose TMT over RC to avoid surgical toxicities with minimal impact on OS. (Figure Presented).