Survival outcomes with radical cystectomy (RC) in localized clinically node-positive bladder cancer (CNBC).

Abstract

520 Background: The role of RC in patients with CNBC remains unclear since most prospective clinical trials excluded them. Our study aims to evaluate overall survival (OS) in patients with CNBC treated with systemic chemotherapy (SC) with or without RC. Methods: We queried the National Cancer Database for adult patients who received SC for localized CNBC during the years 2004 to 2018. Patients with distant metastases, including to non-regional nodes, and those treated with radiation to the bladder or pelvic nodes were excluded. Chi-square and Mann Whitney U tests were used to compare frequency distributions. Cox proportional hazards analysis was employed for multivariate analysis of factors associated with OS. Results: A total of 8464 patients were identified – 3565 (42.1%) underwent RC + SC (RC+), while 4899 (57.9%) received only SC (RC-). Median age at diagnosis was 65y in the RC+ grp vs. 68y in the RC- grp ( P = 0.006). Majority of patients were Caucasian in both grps – 86.9% and 85.1%, respectively. 5y-OS was 34.1% in the RC+ grp vs. 36.1% in the RC- grp ( P = 0.06). On multivariate analysis, factors independently associated with OS were RC+ status (Hazard ratio (HR) 0.81, 95% CI 0.75-0.88, P < 0.001), advanced age (70-85y vs. 18-35y, HR 1.88, 95% CI 1.18-3.01, P < 0.001), female gender (HR 1.20, 95% CI 1.12-1.28, P = 0.001), African American (vs. Caucasian) race (HR 1.24, 95% CI:1.10-1.40, P = 0.0004), ≥ 2 comorbidities (HR 1.67, 95% CI 1.34-1.92, P = 0.001), annual income ( < $30,000 vs > $45,000, HR 1.24, 95% CI 1.13-1.37, P < 0.001), and insurance status (uninsured vs. private, HR 1.39, 1.15-1.67, P < 0.001). Conclusions: In this large retrospective analysis, among patients with localized CNBC who received SC, 5y-OS rates were comparable with or without RC. However, RC was associated with improved OS on multivariate analysis.[Table: see text]