Treatment Patterns and Outcomes in Muscle-Invasive Bladder Cancer
Posted: Monday, August 2, 2021
A study conducted by Karim Chamie, MD, MSHS, of the Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, and colleagues examined the associations between overall survival and treatment patterns with neoadjuvant chemotherapy, partial cystectomy, treatment delays, and lymph node dissection among patients with muscle-invasive bladder cancer. Their results, published in Urologic Oncology: Seminars and Original Investigations, found that ultimately, lymph node dissection adequacy alone was associated with improved overall survival.
The investigators focused on 9,199 patients with cT2–4cN0cM0 urothelial bladder carcinoma and muscle-invasive bladder cancer from the National Cancer Database who had either a partial (n = 655) or radical cystectomy (n = 8,544). Greater odds of receiving a partial cystectomy were associated with clinical stage III disease, older age, and variant histology. In contrast, clinical stage IV disease, female sex, and Medicaid insurance seemed to be associated with lower odds of receiving a partial cystectomy compared with radical cystectomy. Additionally, the utilization of partial cystectomy decreased from 9% to 7% over the study period; however, it was not statistically significant.
Neoadjuvant chemotherapy was administered to individuals who were treated with radical cystectomy (17%) more often than those who were treated with partial cystectomy (7%), and a similar pattern was identified regarding lymph node dissection (91% vs. 57%, respectively). In addition, participants who underwent a partial cystectomy (25%) were found to be less likely to experience delays in treatment than those treated with radical cystectomy (31%).
The median follow-up was 28.5 months, with a median overall survival of 44.3 months. A total of 4.1% of patients who underwent partial cystectomy received neoadjuvant chemotherapy, lymph node dissection, and experienced no treatment delay. According to a multivariable Cox proportional hazards model, lymph node dissection alone was associated with improved overall survival, regardless of the number of lymph nodes dissected (< 10: hazard ratio [HR] = 0.62, P < .01 and ≥10: HR = 0.48, P < .01).
Disclosure: The study authors reported no conflicts of interest.