Abstract
Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.
Highlights
Bladder cancer is the most common cancer of the urinary system among the American population, and an estimated 83,730 new cases of bladder cancer and 17,200 deaths are expected to occur in the United States in 2021 [1]
The recent guidelines recommend that low- and intermediate-risk non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by a single postoperative instillation of intravesical chemotherapy within 24 hours of transurethral resection of bladder tumor (TURBT) [4]
Chemotherapy did not have any effect on overall mortality (HR 0.84; 95% confidence intervals (CI) 0.65-1.07; p value 0.159)
Summary
Bladder cancer is the most common cancer of the urinary system among the American population, and an estimated 83,730 new cases of bladder cancer and 17,200 deaths are expected to occur in the United States in 2021 [1]. The recent guidelines recommend that low- and intermediate-risk NMIBC should be treated with transurethral resection of the bladder tumor (TURBT) followed by a single postoperative instillation of intravesical chemotherapy within 24 hours of TURBT [4]. While the guidelines recommend and clinical trials have shown the benefits, there is no large-scale study from realworld databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT [4 - 7]. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. There is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
