Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa).
We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice.
Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors.
A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis.
Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC-in a patient group with poor survival-this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023 Jul 21 [Epub ahead of print]
Martin Swinton, Neethu Billy Graham Mariam, Jean Ling Tan, Katherine Murphy, Thiraviyam Elumalai, Manjusha Soni, Alexandra Ferrera, Charlotte Richardson, Richard Walshaw, Hitesh Mistry, Vijay Ramani, Yeepei Song, Alison Birtle, Ann Henry, Joachim Chan, Peter Hoskin, Ananya Choudhury
Christie Hospital NHS Foundation Trust, Manchester, United Kingdom., Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom., Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom., Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom., Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37478391