Trimodal therapy (TMT) is guideline-recommended for the management of organ confined urothelial carcinoma of urinary bladder (UCUB). However, temporal trends in TMT use and cancer-specific mortality free-survival (CSM-FS) between historical TMT versus contemporary TMT have not been assessed. We addressed this knowledge gap.
Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified nonmetastatic UCUB patients with cT2-T4aN0-N2 treated with TMT, defined as the combination of transurethral resection of bladder tumor, chemotherapy and radiotherapy. Temporal trends described TMT use over time. Subsequently, patients were divided between historical (2004-2012) versus contemporary (2013-2020) cohorts. Survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression (MCR) models addressed CSM-FS. Separate analyses addressed patients with organ confined (OC: cT2N0M0) versus nonorgan confined (NOC: cT3-4a and/or cN1-2) clinical stages.
Of 4,097 assessable UCUB TMT patients, 1744 (43%) were treated in the historical period (2004-2012) versus 2353 (58%) in the contemporary period (2013-2020). TMT use increased over time in OC patients (EAPC:+3.4%, P < .001), as well as in NOC (EAPC:+2.7%, P < .001). In OC stage, median CSM-FS was 55.3% in historical versus 49.0% in contemporary patients (HR:0.75, P < .001). Similarly, in NOC stage, 5-year median CSM-FS was 43.0% in historical versus 32.8% in contemporary patients (HR:0.78, P = .01).
TMT rates have increased over time in both OC and NOC patients. Contemporary TMT patients benefit of better cancer-specific survival. Interestingly, this benefit applies equally to OC and NOC TMT-treated patients.
Clinical genitourinary cancer. 2024 May 10 [Epub ahead of print]
Mario de Angelis, Lukas Scheipner, Carolin Siech, Letizia Maria Ippolita Jannello, Andrea Baudo, Francesco Di Bello, Jordan A Goyal, Kira Vitucci, Zhe Tian, Nicola Longo, Sascha Ahyai, Ottavio de Cobelli, Felix K H Chun, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Giorgio Gandaglia, Marco Moschini, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Departmen of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Cancer Prognostics and Health Outcomes Unit, Department of Urology, University of Montréal Health Center, Montréal, Québec, Canada., Department of Urology, University Hospital, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Medical University of Graz, Graz, Austria., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Division of Experimental Oncology/Departmen of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.