Practice patterns and survival outcomes for Muscle-Invasive Bladder Cancer: real-life experience in a general population setting

Abstract

Abstract Background: Bladder cancer (BC) is a common malignancy in Europe and in North America. Among BC, muscle-invasive bladder cancers (MIBC) are distinguished, as they require aggressive treatment due to their spreading potential and the poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. Methods: MIBC among BC incident in 2011 and 2012 recorded in a French population-based cancer registry (810,000 inhabitants) were included in the study. Data was extracted from the medical files. Individual, tumour related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, treatment delivered were described. Cystectomy, chemoradiation, radiotherapy and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline’s recommendations. Overall survival (using the Kaplan-Meier method) and net survival (using the Poher-Perme estimator) were calculated. Results: Among 538 incident BC cases, 147 (27.3%) were MIBC. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n=136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days [First quartile:12-third quartile:32]. Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (+/- neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline’s recommendations. Forty people only received supportive care. Still, five-year overall and net survival were poor, being 19% [13-26] and 22% [14-31] respectively. Five-year net survival was 35% [23-48] for people who underwent curative-intent treatments. Conclusion: MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained.