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- Title
Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation.
- Authors
Riveros, Carlos; Ranganathan, Sanjana; Haque, Waqar; Huang, Emily; Jiaqiong Xu; Kulkarni, Girish S.; Geng, Michael; Anis, Maryam; Muhammad, Taliah; Chan, Keith Syson; Farach, Andrew; Teh, Bin S.; Miles, Brian J.; Klaassen, Zachary; Sonpavde, Guru P.; Wallis, Christopher J. D.; Satkunasivam, Raj
- Abstract
INTRODUCTION: Elective pelvic nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiation (WP-CCR) compared to bladder-only (BO)-CCR has not been demonstrated. Using realworld data from the National Cancer Database (NCDB), we sought to compare the overall survival (OS) between BO-CCR and WP-CCR for MIBC. METHODS: Using the 2020 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2019. We selected patients with clinical T2-T4aN0M0 disease receiving CCR as first-line treatment. CCR was defined as transurethral resection of bladder tumor followed by =40 Gy radiation to the bladder with concurrent single- or multiple-agent chemotherapy. Based on elective nodal irradiation status, patients were stratified as having received BO-CCR vs. WP-CCR. OS analysis was performed using summary three-month conditional landmark, inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier estimates, and Cox regression. RESULTS: A total of 604 patients receiving CCR for MIBC were identified: 367 (60.8%) BO-CCR and 237 (39.2%) WP-CCR. Before IPTW, the groups were imbalanced in terms of baseline characteristics. The median followup of the weighted population was 42.3 months (interquartile range 18.1-49.1 months). In IPTW-adjusted Cox proportional hazards regression analysis, WP-CCR was associated with a significant OS benefit compared to BO-CCR (adjusted hazard ratio 0.72, 95% confidence interval 0.54-0.96, p=0.026). CONCLUSIONS: In the setting of CCR for N0 MIBC, this retrospective NCDB analysis revealed that WP-CCR was associated with a benefit in OS compared to BO-CCR.
- Subjects
BLADDER tumors; CONFIDENCE intervals; OPERATIVE surgery; TRANSURETHRAL resection of bladder; ANTINEOPLASTIC agents; REGRESSION analysis; RETROSPECTIVE studies; ACQUISITION of data; CHEMORADIOTHERAPY; TREATMENT effectiveness; COMPARATIVE studies; KAPLAN-Meier estimator; DESCRIPTIVE statistics; MEDICAL records; OVERALL survival; PROPORTIONAL hazards models; EVALUATION
- Publication
Canadian Urological Association Journal, 2024, Vol 18, Issue 2, p17
- ISSN
1911-6470
- Publication type
Article
- DOI
10.5489/cuaj.8386