Comparing Long-Term Survival Outcomes for Muscle-Invasive Bladder Cancer Patients Who Underwent with Radical Cystectomy and Bladder-Sparing Trimodality Therapy: A Multicentre Cohort Analysis

Junlan Qiu; Haifeng Zhang; Dongkui Xu; Lin Li; Lingkai Xu; Yiqing Jiang; Tao Wen; Shun Lu; Fang Meng; Lin Feng; Xiaochen Shu

doi:10.1155/2022/7306198

Comparing Long-Term Survival Outcomes for Muscle-Invasive Bladder Cancer Patients Who Underwent with Radical Cystectomy and Bladder-Sparing Trimodality Therapy: A Multicentre Cohort Analysis

J Oncol. 2022 May 14:2022:7306198. doi: 10.1155/2022/7306198. eCollection 2022.

Authors

Junlan Qiu¹, Haifeng Zhang², Dongkui Xu³, Lin Li², Lingkai Xu⁴, Yiqing Jiang⁵, Tao Wen⁶, Shun Lu⁷, Fang Meng^{8

9}, Lin Feng¹, Xiaochen Shu^{2

10}

Affiliations

¹ Department of Oncology and Hematology, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou 215153, China.
² Department of Epidemiology, School of Public Health, Soochow University, Suzhou 215123, China.
³ VIP Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
⁴ Department for Communicable Disease Control and Prevention, Suzhou Wuzhong Center for Disease Prevention and Control, Suzhou 215128, China.
⁵ Department of General Surgery, Harrison International Peace Hospital, Hengshui 053000, China.
⁶ Medical Research Centre, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
⁷ Department of Radiation Oncology, Sichuan Cancer Hospital/Institute, University of Electronic Science and Technology of China, 610041 Chengdu, China.
⁸ Centre of Systems Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁹ Suzhou Institute of Systems Medicine, Suzhou 215123, China.
¹⁰ Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou 215123, China.

Abstract

Background: Although radical cystectomy (RC) is the clinical practice guideline-recommended treatment of muscle-invasive bladder cancer (MIBC), bladder-sparing trimodality therapy (TMT) has emerged as a valid treatment option. Findings comparing the survival outcomes for MIBC patients who underwent RC and TMT are inconclusive.

Objective: We designed a large hospital-based multicohort study to compare the effectiveness of TMT with RC.

Methods: Information on deaths was jointly retrieved from EMR (electronic medical record), cause of death registry, and chronic disease surveillance as well as study-specific questionnaire. To avoid the systematical difference between patients who received two modalities, RC-MIBC cohort was propensity score-matched to TMT-MIBC cohort, and the Cox proportional hazard regression was used to calculate the overall survival (OS) and disease-specific survival (DSS).

Results: There were 891 MIBC patients treated with RC and another 891 MIBC patients who underwent with TMT in the propensity score matching. Comparable effectiveness between two modalities was observed for DSS (HR, 1.20; 95% confidence interval (CI), 0.94 to 1.49) and OS (HR, 1.17; 95% CI, 0.91 to 1.43) according to multiple adjustment after a median follow-up of approximately 9.3 years. However, a relatively higher mortality rate around 5 years after TMT treatment was found compared to RC (HR, 1.26; 95% CI, 1.01 to 1.53). The respective 5-year OS rates were 69% and 73% for TMT cohort and RC cohort, respectively.

Conclusions: Our findings supported that MIBC patients with TMT yielded survival outcomes comparable to MIBC patients who underwent RC overall. Treatment options should be suggested considering patients' age and willingness.