Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer

Chad R. Ritch, Raymond Balise, Nachiketh Soodana Prakash, David Alonzo, Katherine Almengo, Mahmoud Alameddine, Vivek Venkatramani, Sanoj Punnen, Dipen J. Parekh, Mark L. Gonzalgo

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)745-751
Number of pages7
JournalBJU International
Volume121
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

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Cystectomy
Survival Analysis
Urinary Bladder Neoplasms
Muscles
Survival
Therapeutics
Mortality
Confidence Intervals
Comorbidity
Radiation
Histology
Databases
Morbidity
Drug Therapy

Keywords

  • #BladderCancer
  • #blcsm
  • bladder preservation
  • chemoradiation
  • radical cystectomy
  • radiotherapy

ASJC Scopus subject areas

  • Urology

Cite this

Ritch, C. R., Balise, R., Prakash, N. S., Alonzo, D., Almengo, K., Alameddine, M., ... Gonzalgo, M. L. (2018). Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. BJU International, 121(5), 745-751. https://doi.org/10.1111/bju.14109

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 journalArticle

Ritch, CR, Balise, R, Prakash, NS, Alonzo, D, Almengo, K, Alameddine, M, Venkatramani, V, Punnen, S, Parekh, DJ & Gonzalgo, ML 2018, 'Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer', BJU International, vol. 121, no. 5, pp. 745-751. https://doi.org/10.1111/bju.14109
Ritch, Chad R. ; Balise, Raymond ; Prakash, Nachiketh Soodana ; Alonzo, David ; Almengo, Katherine ; Alameddine, Mahmoud ; Venkatramani, Vivek ; Punnen, Sanoj ; Parekh, Dipen J. ; Gonzalgo, Mark L. / Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. In: BJU International. 2018 ; Vol. 121, No. 5. pp. 745-751.
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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.",
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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.

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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.

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