Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database

Janopaul‐Naylor, James; Zhong, Jim; Liu, Yuan; Zhang, Chao; Osunkoya, Adeboye O.; Joshi, Shreyas; Bilen, Mehmet Asım; Carthon, Bradley Curtis; Küçük, Ömer; Hartsell, Lindsey; Shelton, Joseph; Jani, Ashesh B.

doi:10.1016/j.ctro.2020.11.002

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…Few reports compared cancer control outcomes after TMT between UCUB and non-urothelial VH patients [ 10 , 11 ]. We addressed this void and hypothesized that no differences would distinguish VH from UCUB in TMT-treated T2N0M0 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, NCDB only allows overall survival analyses and CSM cannot be distinguished from other-cause mortality. In a different study, which also focused on TMT-treated patients, Janopaul-Naylor et al [ 10 ] (NCDB 2004–2015) tested for overall survival differences in RC- and TMT-treated patients according to different histological subtypes. The authors reported worse overall survival for squamous cell carcinoma TMT-treated patients (n = 94, HR 1.49, 95% CI 1.25–1.77, p < 0.001) as well as for adenocarcinoma TMT-treated patients (n = 38, HR 1.75, 95% CI 1.36–2.25, p < 0.001) vs. their RC counterparts harboring the same histological subtype.…”

Section: Discussionmentioning

confidence: 99%

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Differences in Cancer-Specific Mortality after Trimodal Therapy for T2N0M0 Bladder Cancer according to Histological Subtype

Barletta

Tappero

Panunzio

et al. 2022

Cancers

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We aimed at assessing the impact of non-urothelial variant histology (VH), relative to urothelial carcinoma of the urinary bladder (UCUB), on cancer-specific mortality (CSM) in T2N0M0 bladder cancer patients treated with trimodal therapy (TMT). TMT patients treated for T2N0M0 bladder cancer were identified within the Surveillance, Epidemiology, and End Results database (2000−2018). Patients who underwent TMT received trans-urethral resection of the bladder tumor, chemotherapy, and radiotherapy. CSM-FS rates were tested using Kaplan–Meier plots and multivariable Cox-regression (MCR) models according to histological subtype: UCUB vs. neuroendocrine carcinoma vs. squamous cell carcinoma vs. adenocarcinoma. A total of 3846 T2N0MO bladder cancer patients treated with TMT were identified. Of these, 3627 (94.3%) harbored UCUB, while 105 (2.7%), 85 (2.2%), and 29 (0.8%) harbored neuroendocrine carcinoma, squamous cell carcinoma, and adenocarcinoma, respectively. In Kaplan–Meier analyses, 3-yr CSM-FS rates were 57% for UCUB, 51% for neuroendocrine carcinoma, 35% for squamous cell carcinoma, and 60% for adenocarcinoma (p-value < 0.0001). In MCR models, only squamous cell carcinoma exhibited higher CSM than UCUB (HR 1.98, 95%CI 1.5–2.61, p-value < 0.001). Despite the small number of observations, squamous cell carcinoma distinguished itself from UCUB based on worse survival in T2N0M0 patients after TMT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Differences in Cancer-Specific Mortality after Trimodal Therapy for T2N0M0 Bladder Cancer according to Histological Subtype

Barletta

Tappero

Panunzio

et al. 2022

Cancers

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“…Those with bladder cancer with adenocarcinoma or squamous cell carcinoma had worse survival outcomes associated with bladder preservation therapy compared to cystectomy. 13 better OS compared to those receiving CCRT before propensity score matching, whereas OS was similar between groups after propensity score matching. 14 In a retrospective multi-institutional study, Zlotta et al found no differences in CSS and DFS between radical cystectomy and bladder preservation therapy.…”

Section: Discussionmentioning

confidence: 88%

“…Fully 30%–40% of their patients had non‐urothelial histologic types of diseases. Those with bladder cancer with adenocarcinoma or squamous cell carcinoma had worse survival outcomes associated with bladder preservation therapy compared to cystectomy 13 . Lin et al.…”

Section: Discussionmentioning

confidence: 99%

Comparative survival analysis of bladder preservation therapy versus radical cystectomy in muscle‐invasive bladder cancer

Kang,

Feng,

Lin

et al. 2024

Cancer Medicine

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BackgroundBladder preservation therapy is an alternative to radical cystectomy in patients with muscle‐invasive bladder cancer (MIBC). The purpose of this study is to compare survival outcomes between bladder preservation therapy and radical cystectomy in MIBC patients using an Asian nationwide cancer registry database.MethodsFrom the Taiwan Cancer Registry database and the Taiwan National Health Insurance Research Database, we identified bladder cancer patients from 2008 to 2018. The patients with urothelial carcinoma and clinical stage T2‐T4aN0‐1 M0 were included. Propensity score matching by age, gender, clinical stage, cT classification, and Charlson Comorbidity Index score was used between those receiving bladder preservation therapy or radical cystectomy. Overall survival (OS), cancer‐specific survival (CSS), and disease‐free survival (DFS) were compared using the Kaplan–Meier method. Multivariate Cox regression models were used to determine the predictive factors of OS, CSS, and DFS.ResultsFollowing the propensity score matching, 393 MIBC patients were analyzed, 131 (33.3%) receiving bladder preservation therapy and 262 (66.7%) receiving radical cystectomy. After 5 years of the follow‐up period the overall duration was with a median of 15.6 months. The treatment groups did not differ significantly in OS, CSS, and DFS (p = 0.2681, 0.7208, and 0.3616, respectively). In multivariable Cox regression models, bladder preservation therapy remained non‐inferior to radical cystectomy in OS (adjusted hazard ratio [aHR] 1.08; 95% confidence interval [CI], 0.77–1.50; p = 0.6689), CSS (aHR, 1.06; 95% CI, 0.72–1.57; p = 0.7728), and DFS (aHR, 0.76; 95% CI, 0.46–1.27; p = 0.2929). Additionally, among patients ≥80 years, the use of bladder preservation therapy compared with radical cystectomy resulted in an equivalent OS, CSS and DSS.ConclusionIn Asian populations, bladder preservation therapy yielded similar survival outcomes as radical cystectomy in MIBC patients. Based on the results, it is evident that a multidisciplinary approach and shared decision‐making are recommended for bladder cancer treatment.

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“…Most chemoradiation regimens for MIBC employ concurrent cisplatin with significant remissions and better survival [21]. Survival rates are similar to those achieved by primary cystectomy [22] and have proven superior for T3b and T4 tumors [23].…”

Section: Discussionmentioning

confidence: 98%

Abbreviated Concurrent Chemo-Radiotherapy in Node Negative Muscle-Invasive Bladder Cancer

2021

SECI Oncology Journal

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Background Bladder cancer represents a major economic burden in egypt, ranking as the second most common tumor in males 12.7%. Therefore, the goal of this research is to develop a hypofractionated treatment regimen that achieves a similar response at a lower cost and with less strain on the radiation machines. Purpose: The aim of this study is to evaluate treatment outcome of hypofractionated concurrent chemo-radiotherapy using weekly cisplatin in muscle-invasive bladder cancer (MIBC). Materials and methods: From September 2019 till February 2021, 40 patients with node-negative muscle-invasive transitional cell carcinoma of the bladder, stage T2-T3N0M0, underwent maximal transurethral resection of bladder tumor followed by 3-dimensional conformal radiotherapy to the bladder in 45 Gy in 15 fractions with a weekly cisplatin dose of 30mg/m2. Treatment outcome was assessed by response and toxicity. Results: With a median follow-up time of 13 months (8-18 months), forty patients with a median age of 55.9 ± 8.4 years completed their treatment regimen. After 3 months of therapy, 26 patients (65%) had a complete local response, whereas 6 patients (15%) had progressive disease, 4 patients (10%) had local recurrence and 2 patients (5%) had with distant metastasis. Acute grade 3 gastrointestinal and genitourinary toxicities were 5% and 12.5% of all acute toxicities, respectively. 2.5% of patients had late grade 3 genitourinary toxicity. There were no reports of life-threatening complications or grade 4 toxicity. Conclusions: In node-negative bladder cancer, concurrent chemo-radiotherapy is a feasible and well-tolerated alternative to surgery. In addition to lower morbidity, this regimen offers effective treatment with low cost. However, T2 masses which were completely resected yielded better results. Recommendation: More advanced radiotherapy techniques as IMRT and VMAT can be experimented in further studies with larger number of patients and longer follow-up. Careful selection of patients with T2 completely resected masses and negative nodal status on MRI will yield better results.

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Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database

Abstract: Highlights Muscle invasive bladder cancer with variant histology has worse outcomes. Chemoradiation is associated with similar OS to surgery for variant histology. Adenocarcinoma and SCC have worse OS associated with chemoRT compared to surgery.

Cited by 10 publications

References 21 publications

Differences in Cancer-Specific Mortality after Trimodal Therapy for T2N0M0 Bladder Cancer according to Histological Subtype

Differences in Cancer-Specific Mortality after Trimodal Therapy for T2N0M0 Bladder Cancer according to Histological Subtype

Comparative survival analysis of bladder preservation therapy versus radical cystectomy in muscle‐invasive bladder cancer

Abbreviated Concurrent Chemo-Radiotherapy in Node Negative Muscle-Invasive Bladder Cancer

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