Muscle-Invasive Bladder Cancer: Evaluating Treatment and Survival in the National Cancer Data Base
Smith AB, Deal AM, Woods ME, Wallen EM, Pruthi RS, Chen RC, Milowsky MI, Nielsen ME. BJU Int. 2013 Dec 11. doi: 10.1111/bju.12601. [Epub ahead of print]

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Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina.

Abstract

OBJECTIVE: To evaluate the association between patterns of care and patient survival for the treatment of muscle-invasive bladder cancer (MIBC) using a large, national database.

PATIENTS AND METHODS: We identified a cohort of 36,469 patients with MIBC (Stage II) from 1998 to 2010 from the National Cancer Data Base. Patients were stratified into four treatment groups: radical cystectomy, chemo-radiation, other therapy, or no treatment. Overall survival (OS) between groups was evaluated using the Kaplan Meier (KM) method and Log Rank test. A multivariable Cox proportional hazards model was fit to evaluate the association between treatment groups with OS.

RESULTS: Among treatment groups, 27% received radical cystectomy, 10% chemo-radiation, 61% other therapy, and 2% no treatment. Unadjusted KM analysis showed significant differences by group, with cystectomy having the greatest median OS (48 months) followed by chemo-radiation (28 months), other therapy (20 months), and no treatment (5 months). When controlling for multiple covariates, OS for cystectomy was similar to chemo-radiation (HR 1.05, 95% CI 0.98, 1.12), but superior to other therapy (HR 1.42; 95% CI 1.35, 1.48), and no treatment (HR 2.40; 95% CI 2.12, 2.72). OS for chemo-radiation was superior to other therapy and no treatment.

CONCLUSIONS: Radical cystectomy and chemo-radiation are significantly underutilized despite a substantial survival benefit compared to other therapies or no treatment. Future studies are needed to optimize care delivery and improve outcomes for patients with MIBC.