Abstract: PD62-07
Sources of Funding: None.

Introduction

Trimodal therapy (TMT) with transurethral resection, followed by chemotherapy and radiation for muscle invasive urothelial carcinoma (UC) is typically reserved for patients deemed unfit for radical cystectomy (RC). Recently, some studies have demonstrated reasonable oncologic outcomes after TMT for select patients with muscle invasive UC. We assessed practice patterns for TMT in patients with muscle invasive UC using data from the National Cancer Database (NCDB).

Methods

We identified patients with muscle invasive UC of the bladder treated with either RC or TMT between 2004 and 2013. TMT was defined by patients who had transurethral resection plus chemotherapy and radiation therapy within 90 days. Trends in utilization of TMT over time were measured. We compared socioeconomic and clinical variables including age, race, distance from residence to treatment center, urban vs rural residence, median county income, facility type and volume, Charlson comorbidity score (CCS), tumor size and grade, and clinical nodal status between patients receiving RC and TMT and identified predictive factors for receipt of TMT with logistic regression modeling.

Results

Using the NCDB, we identified 18,084 patients that underwent RC (15,722) or TMT (2,362) for cT2 UC of the bladder. TMT patients were older (median 76 vs 68 years), had higher CCS, and higher rates of clinical node positive disease (for all comparisons, p < 0.001). Tumor size was similar between groups. On multivariable analysis, significant predictors of TMT included increasing age (OR = 4.48 [4.05 – 4.96]), rural residence (OR = 1.27 [1.11 – 1.45]), and facility type (those in an integrated network cancer program were 1.44 times as likely to undergo bladder sparing as those treated at community cancer centers [1.11-1.88]).Negative predictors for TMT were treatment at an academic center (OR = 0.59 [0.48 – 0.73]), treatment at a high volume center (OR = 0.35 [0.29 – 0.43]), and longer distance of residence from treatment center (OR = 0.30 [0.29 – 0.37]). The proportion of patients receiving TMT decreased over the study period.

Conclusions

Older patients who live in rural areas were more likely to undergo TMT. Treatment at high volume, academic centers and distant residence from treatment center were all negative predictors for receipt of TMT. Further analyses of these two groups is necessary to determine whether these patterns of treatment impact survival of patients with muscle invasive UC.

Funding

None.