Introduction

Current projections of survival for patients with metastatic urothelial carcinoma of the bladder (TanyNanyM1; mUCB) are based largely on data from patients treated in clinical trials. As patients enrolled in trials are highly-selected, the degree to which these outcomes reflect real-world experience is unknown. We sought to describe practice patterns and survival for patients with mUCB in a large national cancer registry.

Methods

We reviewed the National Cancer Database to identify patients diagnosed with mUCB at presentation between 2004-2012. Sites of metastases were classified as non-regional lymph node (NRLN) only versus any non-nodal (visceral) metastatic disease (VM). Overall survival (OS) was assessed using the Kaplan-Meier method and compared with the log-rank test.

Results

mUCB was present at diagnosis in 3,374 patients. Median age was 71 (IQR 62, 79); 70% were male. The majority (n=2,486; 82%) were diagnosed with VM. Median OS was 5.5 months (95% CI 5.1-5.9), with an estimated 1 and 3-year OS of 27% and 7%, respectively. Patients with VM disease had a significantly inferior OS compared to patients with NRLN (median 5 vs 11 mo; p<0.01). In total, 1,325 (39%) patients with mUCB received treatment, including chemotherapy (30%), multimodal therapy (5%), surgery (3%), and radiation (1%). Median OS varied significantly (p<0.01) across treatments: multimodal (12.6 mo), chemotherapy (10.6 mo), radiation (6.9 mo), and surgery (5.4 mo). OS among patients receiving palliative therapy only (n=935; 28%) was 4.8 mo, and was 2.0 mo for those patients who did not receive treatment (n=1,114; 33%). The longest median OS (13.8 mo; 95% CI 12.9-15.9) was noted among the cohort with NRLN who received chemotherapy (5%), while patients with VM treated with chemotherapy (23%) had a median OS of 9.9 mo (IQR 9.3, 10.7) (Figure).

Conclusions

In our analysis of national practice, we found that patients with mUCB have a poor OS, with a median survival less than six months and only 27% surviving 1 year from diagnosis. Notably, over half of mUCB patients did not receive treatment or received palliative therapy only. Patients receiving chemotherapy for NRLN had an OS approaching that reported from clinical trials, although such patients represented just 5% of the overall mUCB cohort.

Funding

None