Trends in Management and Outcomes among Patients with Urothelial Carcinoma Undergoing Radical Cystectomy from 1995 to 2015: The Memorial Sloan Kettering Experience

Abstract

To evaluate trends in oncologic characteristics and outcomes, as well as perioperative management, among patients undergoing radical cystectomy at Memorial Sloan Kettering from 1995 to 2015. Materials and Methods:We retrospectively reviewed our institutional database to analyze changes in disease recurrence probability, cancer-specific and all-cause mortality, incidence of muscle-invasive bladder cancer, use of perioperative chemotherapy, rate of positive soft-tissue surgical margins, and lymph node yield. Results:In 2,740 patients with non-metastatic urothelial carcinoma undergoing radical cystectomy from 1995 to 2015, the 5-year probability of disease recurrence decreased from a peak of 42% in 1997 to 34% in 2013 (p=0.045), while 5-year probability of cancer-specific mortality likewise declined from 36% in 1997 to 24% in 2013 (p=0.009). Incidence of non-muscle-invasive disease before radical cystectomy did not change, comprising 30%-35% of patients across the study period. Use of neoadjuvant chemotherapy rose significantly: 57% of patients with muscleinvasive bladder cancer from 2010 to 2015 received it. We observed a corresponding rise in complete pathologic response (pT0) at radical cystectomy, as well as decreasing positive softtissue surgical margins (10% to 2.5%) and rising lymph node yield (7 to 24) from 1995 to 2015.Conclusions: Over a 21-year period, outcomes after radical cystectomy at our institution improved significantly, as probability of recurrence and cancer-specific mortality decreased. Increasing utilization of neoadjuvant chemotherapy, rising pT0 rates, decreased positive soft-tissue surgical margins, and increasing lymph node yields likely contributed, suggesting that optimized surgical and perioperative care led to improved cancer outcomes in patients undergoing radical cystectomy.

A systematic review and meta-analysis of radical cystectomy in the treatment of muscular invasive bladder cancer (MIBC)

“…Six articles analyzed the 5-year DMR in RCTs and tested the overall heterogeneity (Chi 2 =1.68, df =5, I 2 =0%, and P=0.89>0.1). The analysis results of the FEM indicated that the 2 groups showed no statistically observable difference, which was consistent with the findings of Almassi et al (2020) (19).…”

Young age increases the risk of lymph node positivity but improves prognosis in patients with bladder cancer treated via cystectomy: a population-based study

“…In general, younger patients tend to be healthier, with favorable immune function and nutritional status as well as a lower risk of comorbidities and fewer treatment-related complications. Previous studies have suggested that younger patients prefer to undergo more complete, radical, and combined treatment modalities than older patients (e.g., LND or extensive LND during RC combined with chemotherapy)-a finding also reflected in our study (13)(14)(15)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Indeed, in our study, rates of chemotherapy and the median number of LNE were higher in patients <50 years of age than in patients ≥80 years of age.…”

“…LN+, lymph node positivity; NMIBC, non-muscle-invasive bladder cancer.with the LNE while ignoring the impact of age on LN+. In their analysis of data from patients with UC undergoing RC, Almassi et al observed that LNE increased (7 to 24), while LN+ decreased (19% to 8.7%), from 1995 to 2015(20). However, they did not group patients by age for further discussion.…”

An epithelial–mesenchymal transition-related long noncoding RNA signature correlates with the prognosis and progression in patients with bladder cancer

“…Thanks to the improvement of surgical methods and medical therapy, great progress has been made in the treatment of bladder cancer. However, the relapse and metastasis after operation has not been solved, and the 10-year survival rate is still unsatisfied [ 14 , 15 ].…”