A propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic.

Media type: E-Article

Title: A propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic

Contributor: Kulkarni, Girish S.; Hermanns, Thomas; Wei, Yanliang; Bhindi, Bimal; Satkunasivam, Raj; Bostrom, Peter; Kuk, Cynthia; Li, Kathy; Erlich, Annette; Templeton, Arnoud J.; Sridhar, Srikala S.; van der Kwast, Theodorus; Chung, Peter W. M.; Bristow, Robert G.; Milosevic, Michael F.; Warde, Padraig Richard; Fleshner, Neil Eric; Jewett, Michael A.S.; Bashir, Shaheena; Zlotta, Alexandre

imprint: American Society of Clinical Oncology (ASCO), 2017

Language: English

DOI: 10.1200/jco.2017.35.15_suppl.e16003

ISSN: 1527-7755; 0732-183X

Keywords: Cancer Research ; Oncology

Origination:

Footnote:

Description: e16003 Background: Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. While radical cystectomy (RC) is currently viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) combining transurethral resection of bladder tumor, chemotherapy for radiation sensitization and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, we compared the oncological outcomes between patients managed by RC or TMT using a propensity-score matched cohort analysis. Methods: Patients seen in our multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were retrospectively reviewed. Those who received TMT for MIBC were identified and matched (for gender, cT and cN stage, ECOG status, Charlson comorbidity score, treatment date, age, CIS, hydronephrosis) using propensity scores, to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox Proportional hazards modeling and competing risk analysis, respectively. Results: 112 patients with MIBC were included after matching, 56 treated with TMT and 56 by RC. Median age was 68.0 years and 29.5% were cT3/cT4. At a median follow up of 4.51 years, there were 20 (35.7%) deaths (13 from BC) in the RC group and 22 (39.3%) deaths (13 from BC) in the TMT group. 5 year DSS was 73.2% and 76.6%, in the RC and TMT groups, respectively (p = 0.49). Salvage cystectomy was performed in 6/56 TMT patients (10.7%). Conclusions: In the setting of a MDBCC, TMT yielded survival outcomes similar to matched RC patients. Appropriately selected MIBC patients should be offered the opportunity to discuss various treatment options including organ-sparing TMT.

Access State: Open Access

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