Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis.

Yeon Joo Kim,Sang Jun Byun,Beom-Sik Hong,Choung-Soo Kim,Hanjong Ahn,Sangjun Yoo,Jae-Lyun Lee,Young Seok Kim

doi:10.18632/oncotarget.16576

Yeon Joo Kim, Sang Jun Byun + Show 6 more

Open Access

https://doi.org/10.18632/oncotarget.16576

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Journal: Oncotarget	Publication Date: Mar 25, 2017
Citations: 32	License type: cc-by

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

Although radical cystectomy (RC) is considered as the standard therapy for muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) combining transurethral resection of the tumor with radiotherapy and chemotherapy is increasingly recommended as an alternative approach for bladder preservation. In the absence of randomized trials, we compared the clinical outcomes between RC and TMT using propensity score matching with 50 patients in the RC arm and 29 patients in the TMT arm. With respective median follow-up periods of 23 and 32 months for the RC and TMT groups, 5-year distant metastasis-free survival (58% vs. 67%), overall survival (56% vs. 57%), and cancer-specific survival (69% vs. 63%) rates between the RC and TMT groups, respectively, were similar. However, the 5-year local recurrence-free survival was significantly better in the RC group than in the TMT group (74% vs. 35%). Following TMT, acute grade 3 hematological (n = 2) and late grade 3 genitourinary (n = 1) toxicities were reported. These findings demonstrated that oncological outcomes of TMT were comparable with those of RC, except for poorer local control. Large-scale, randomized trials are warranted to confirm the findings of the present retrospective comparison and to guide toward best treatment options.

Highlights

Radical cystectomy (RC) has been the mainstay treatment for muscle-invasive bladder cancer (MIBC), many patients with several comorbidities are unfit for radical cystectomy (RC)
As neoadjuvant and adjuvant chemotherapy, four cycles of gemcitabine at 1,000 mg/m2 combined with cisplatin at 70 mg/m2 on day 1 and followed by gemcitabine 1,000 mg/m2 on day 8 were administered at 3-week intervals
A surgical series reported that the 10-year local recurrencefree survival (LRFS) ranged from 84% to 97% in lymph node (LN)-negative MIBC patients [9,10,11], whereas the 5-year LRFS in several Radiation Therapy Oncology Group (RTOG) trials ranged between 39% and www.impactjournals.com/oncotarget

Summary

Introduction

Radical cystectomy (RC) has been the mainstay treatment for muscle-invasive bladder cancer (MIBC), many patients with several comorbidities are unfit for RC. As some patients strongly prefer to retain their own bladders, interest in trimodal therapy (TMT), which combines transurethral resection (TUR) of bladder tumor with radiotherapy (RT), and chemotherapy, is increasingly considered as alternative therapy for MIBC. Accumulating evidence from several studies indicated that patients receiving TMT tended to be older and had more comorbidities and poorer performance status than those treated with surgery alone, making accurate comparisons impossible. Discrepancies between clinical and pathological staging represent another major hurdle in comparisons between the two treatment options. Clinical staging is more likely to underestimate muscle invasion and can occur in up to 50% of patients [5]

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