Radical Cystectomy Superior to Trimodal Therapy for Muscle-Invasive Bladder Cancer
Trimodal therapy for patients with muscle-invasive bladder cancer is associated with worse cancer-specific and overall survival and higher costs compared with radical cystectomy.
Trimodal therapy for muscle-invasive bladder cancer (MIBC) is associated with worse outcomes and higher costs compared with radical cystectomy (RC), investigators concluded during a presentation at the 2019 Genitourinary Cancers Symposium.
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, Mohamed Danny Ray-Zack, MBBS, of the University of Texas Medical Branch at Galveston, and colleagues identified 2963 patients aged 66 years or older diagnosed with clinical stage T2-4a bladder cancer between January 1, 2002, and December 31, 2011. Of these, 728 (24.6%) patients underwent trimodal therapy and 2235 (75.4%) patients underwent RC.
Compared with the RC group, the patients who received trimodal therapy had a significant 1.50-fold increased risk of cancer-specific mortality (hazard ratio [HR], 1.50; 95% CI, 1.32-1.70) and 1.38-fold increased risk death from any cause (HR, 1.38; 95% CI, 1.25-1.53), in adjusted analyses, the investigators reported. Based on propensity score matching, RC was associated with a 1.49-fold increased risk of cancer-specific mortality (HR, 1.49; 95% CI, 1.31-1.69) and 1.55-fold increased risk of death from any cause (HR, 1.55; 95% CI, 1.32-1.83).
An analysis of total costs of treatment over 6 months showed that trimodal therapy cost a median $91,468 more than RC in the propensity score-matched cohort, Dr Ray-Zack and his colleagues reported.
“In the absence of data from randomized controlled trials, this observational study provides further evidence to suggest the superiority of radical cystectomy over trimodal therapy in patients with muscle-invasive bladder cancer,” the authors concluded.