Introduction

Bladder-preserving therapy with transurethral resection of bladder tumor followed by radiotherapy (RT), preferably with concurrent chemotherapy (CRT) is an alternative to Radical Cystectomy (RC) in select patients. Studies suggest improved outcomes with RC at academic centers (ACs) compared to non-academic centers (NACs). There are no data describing the impact of facility type on RT-based treatment. Yet, given the multidisciplinary care needed to execute high-quality multimodality bladder-preserving approaches, some argue that the excellent outcomes seen in bladder-preservation trials can only be reproduced at select centers of excellence, typically AC. We analyzed the National Cancer Database to determine if treatment at an AC is associated with improved overall survival (OS) for patients undergoing RT or CRT for muscle-invasive bladder cancer (MIBC)._x000D_

Methods

Patients diagnosed with cT2-4 N0-3 M0 transitional cell MIBC from 2008 to 2012 and treated with RT or CRT were selected. Facility type was dichotomized into AC and NAC. The Kaplan-Meier method was used for OS. Univariate analysis (UVA) for OS was performed using the Log-Rank test for all clinical, demographic, and treatment-related covariates. Multivariable analysis (MVA) using the Cox proportional hazards model was used to assess the association of facility type with OS while controlling for facility case volume and all other covariates with p-value <0.1 on UVA.

Results

872 patients at 452 unique facilities were selected. 502 (58%) patients received RT, and 370 (42%) patients received CRT. 237 (27%) were treated at an AC, and 635 (73%) were treated at a NAC. 2-year OS was 61% and 53%, for patients receiving 60 Gy or greater at ACs and NACs, respectively. On UVA, facility type was not associated with OS (p=.11). MVA, controlling for facility case volume, age, sex, education, T Stage, N Stage, RT dose, Charlson-Deyo comorbidity score, census region, and population density, demonstrated that although there was a trend, treatment at an AC was not associated with improved OS (Hazard Ratio .86, 95% Confidence Interval .71-1.04; p=.06)._x000D_

Conclusions

Similar survival outcomes are seen in patients with MIBC treated with RT and CRT at ACs and NACs. Thus, these approaches can confidently be offered at all centers with multidisciplinary collaboration and clinician experience, and bladder-preserving therapy should be discussed with patients as a valid option when counseling them prior to treatment.

Funding

none