Abstract
Objective: To compare survival outcome between chemoradiation therapy (CRT) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Patients and Methods: We conducted a retrospective analysis of patients with MIBC (≥cT2, N0, M0) in the National Cancer Database (2004–2013). CRT was defined as a radiation dose of ≥40 Gy and chemotherapy within 90 days of radiation. Descriptive statistics were used to compare groups. RC and CRT patients were propensity matched. Kaplan–Meier analysis was used to compare overall survival (OS). Multivariable Cox regression was used to determine predictors of survival. Results: In all, 8 379 (6 606 RC and 1 773 CRT) patients met the inclusion criteria and 1 683 patients in each group were propensity matched. On multivariable extended Cox analysis, significant predictors of decreased OS were age, Charlson-Deyo Comorbidity score of 1, Charlson-Deyo Comorbidity score of 2, stage cT3–4, and urothelial histology. CRT was associated with decreased mortality at year 1 (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.74–0.96; P = 0.01), but at 2 years (HR 1.4, 95% CI 1.2–1.6; P < 0.001) and 3 years onward (HR 1.5, 95% CI 1.2–1.8; P < 0.001) CRT was associated with increased mortality. The 5-year OS was greater for RC than for CRT (38% vs 30%, P = 0.004). Conclusions: Initially after treatment for MIBC the risk of mortality is lower with CRT compared to RC. However, at ≥2 years after treatment the mortality risk favours RC. Patients who are suitable surgical candidates, with a low risk of morbidity, may be better served by RC.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 745-751 |
| Number of pages | 7 |
| Journal | BJU International |
| Volume | 121 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2018 |
| Externally published | Yes |
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Keywords
- #BladderCancer
- #blcsm
- bladder preservation
- chemoradiation
- radical cystectomy
- radiotherapy
ASJC Scopus subject areas
- Urology
Cite this
Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. / Ritch, Chad R.; Balise, Raymond; Prakash, Nachiketh Soodana; Alonzo, David; Almengo, Katherine; Alameddine, Mahmoud; Venkatramani, Vivek; Punnen, Sanoj; Parekh, Dipen J.; Gonzalgo, Mark L.
In: BJU International, Vol. 121, No. 5, 01.05.2018, p. 745-751.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer
AU - Ritch, Chad R.
AU - Balise, Raymond
AU - Prakash, Nachiketh Soodana
AU - Alonzo, David
AU - Almengo, Katherine
AU - Alameddine, Mahmoud
AU - Venkatramani, Vivek
AU - Punnen, Sanoj
AU - Parekh, Dipen J.
AU - Gonzalgo, Mark L.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective: To compare survival outcome between chemoradiation therapy (CRT) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Patients and Methods: We conducted a retrospective analysis of patients with MIBC (≥cT2, N0, M0) in the National Cancer Database (2004–2013). CRT was defined as a radiation dose of ≥40 Gy and chemotherapy within 90 days of radiation. Descriptive statistics were used to compare groups. RC and CRT patients were propensity matched. Kaplan–Meier analysis was used to compare overall survival (OS). Multivariable Cox regression was used to determine predictors of survival. Results: In all, 8 379 (6 606 RC and 1 773 CRT) patients met the inclusion criteria and 1 683 patients in each group were propensity matched. On multivariable extended Cox analysis, significant predictors of decreased OS were age, Charlson-Deyo Comorbidity score of 1, Charlson-Deyo Comorbidity score of 2, stage cT3–4, and urothelial histology. CRT was associated with decreased mortality at year 1 (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.74–0.96; P = 0.01), but at 2 years (HR 1.4, 95% CI 1.2–1.6; P < 0.001) and 3 years onward (HR 1.5, 95% CI 1.2–1.8; P < 0.001) CRT was associated with increased mortality. The 5-year OS was greater for RC than for CRT (38% vs 30%, P = 0.004). Conclusions: Initially after treatment for MIBC the risk of mortality is lower with CRT compared to RC. However, at ≥2 years after treatment the mortality risk favours RC. Patients who are suitable surgical candidates, with a low risk of morbidity, may be better served by RC.
AB - Objective: To compare survival outcome between chemoradiation therapy (CRT) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Patients and Methods: We conducted a retrospective analysis of patients with MIBC (≥cT2, N0, M0) in the National Cancer Database (2004–2013). CRT was defined as a radiation dose of ≥40 Gy and chemotherapy within 90 days of radiation. Descriptive statistics were used to compare groups. RC and CRT patients were propensity matched. Kaplan–Meier analysis was used to compare overall survival (OS). Multivariable Cox regression was used to determine predictors of survival. Results: In all, 8 379 (6 606 RC and 1 773 CRT) patients met the inclusion criteria and 1 683 patients in each group were propensity matched. On multivariable extended Cox analysis, significant predictors of decreased OS were age, Charlson-Deyo Comorbidity score of 1, Charlson-Deyo Comorbidity score of 2, stage cT3–4, and urothelial histology. CRT was associated with decreased mortality at year 1 (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.74–0.96; P = 0.01), but at 2 years (HR 1.4, 95% CI 1.2–1.6; P < 0.001) and 3 years onward (HR 1.5, 95% CI 1.2–1.8; P < 0.001) CRT was associated with increased mortality. The 5-year OS was greater for RC than for CRT (38% vs 30%, P = 0.004). Conclusions: Initially after treatment for MIBC the risk of mortality is lower with CRT compared to RC. However, at ≥2 years after treatment the mortality risk favours RC. Patients who are suitable surgical candidates, with a low risk of morbidity, may be better served by RC.
KW - #BladderCancer
KW - #blcsm
KW - bladder preservation
KW - chemoradiation
KW - radical cystectomy
KW - radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85045943925&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045943925&partnerID=8YFLogxK
U2 - 10.1111/bju.14109
DO - 10.1111/bju.14109
M3 - Article
VL - 121
SP - 745
EP - 751
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 5
ER -