Introduction

The only randomized controlled trial comparing trimodal therapy (TMT) vs. radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB) failed to meet its accrual target. We sought to examine the comparative effectiveness of TMT vs. RC for muscle-invasive UCB in an observational cohort study.

Methods

Within the National Cancer Data Base (2004-2011), we identified 12,843 individuals who received TMT or RC for definitive treatment of cN0M0 muscle-invasive UCB. Inverse probability of treatment weighting (IPTW) adjusted Kaplan-Meier and Cox regression analyses with time-varying covariate were used to compare overall survival (OS) of patients who received TMT vs. RC. Exploratory analyses according to patient characteristics were also performed.

Results

Overall, 1,257 (9.8%) and 11,586 (90.2%) patients received TMT and RC, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was similar between TMT and RC groups (39.6 [95% CI, 33.7-45.5] vs. 43.0 [95% CI, 40.9-45.1] months; P=0.290; Figure 1). In IPTW-adjusted Cox regression analysis with time-varying covariate, TMT was associated with a significant adverse effect on OS after 25 months of follow-up (HR=1.37;95%CI=[1.16-1.59];P<0.001). In exploratory analyses (Figure 2), there was no significant difference between TMT and RC with regard to long-term OS in individuals aged >=70 (HR=1.21;95%CI=[0.83-1.60];P=0.225), of female gender (HR=1.28;95%CI=[0.83-1.74];P=0.170), with Charlson comorbidity index >=1 (HR=1.10;95%CI=[0.83-1.38];P=0.439) and/or >=cT3 disease (HR=1.16; 95%CI=[0.80-1.52];P=0.338.

Conclusions

We generally observed that TMT was associated with worse long-term OS compared to RC for muscle-invasive UCB. However, selected subgroups of patients may choose TMT over RC to avoid surgical toxicities with minimal impact on OS._x000D_

Funding

none