The authors collected data from 21,295 patients from the French National Hospitalization Database (PMSI). Of these patients, 68.9% had MIBC, 28.9% had UTUC, and 2.2% had both. The median follow-up time was 66 months. The most frequent comorbidities in MIBC and UTUC patients were diabetes, obesity, kidney disease, and chronic pulmonary disease. The authors subsequently analyzed patients with MIBC versus patients with UTUC separately.
Radical surgery alone was the treatment for 80.7% of patients with MIBC. Between 2015 and 2019, neoadjuvant chemotherapy (NAC) treatment increased from 13.8% to 22.2%, while there was no difference in the use of adjuvant chemotherapy (AC). The 24-month disease-free survival (DFS) rate was 43.6% (95% CI, 41.6 – 45.5), and the 24-month overall survival (OS) rate was 62.2% (60.2 – 64.1). The 60-month DFS rate was 34.0% (32.1 – 35.9), and the 60-month OS rate was 48.4% (46.5 – 50.5). The median duration of DFS was 16.0 months (14.0 – 18.0), while the median OS was 54.0 months (47.0 – 63.0).
Radical surgery was the only treatment among 95.1% of patients with UTUC in 2015 and 92.6% in 2019. AC treatment increased from 3.7% and 6.3% between 2015 and 2019. NAC was only used as a treatment modality for around 1% of UTUC patients, with no change between 2015 and 2019. The 24-month DFS rate for patients with UTUC was 51.5% (48.4 – 54.6), and the 24-month OS rate was 83.2% (80.7 – 85.4). The 60-month DFS rate was 35.8% (32.9 – 38.9), while the 60-month OS rate was 68.9% (66.0 – 71.8). The median duration of DFS was 27.0 months (23.0 – 32.0), and the median OS time was not reached.
One of the study's major strengths is the large number of patients that were evaluated. At the same time, limitations included the lack of availability of some relevant clinical features (histological results) and the absence of outpatient data. The increase in the utilization the use of adjuvant and neoadjuvant therapy is notable.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
Reference:
- Roupret M, Brouquet A, Colrat F, et al. Population characteristics, management, and survival outcomes in muscle-invasive urothelial carcinoma undergoing radical resection: the MINOTAUR study [published online ahead of print, 2023 Mar 16]. World J Urol. 2023;1-7.