Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation

Authors

  • Carlos Riveros Department of Urology, Houston Methodist Hospital, Houston, TX
  • Sanjana Ranganathan Department of Urology, Houston Methodist Hospital, Houston, TX
  • Waqar Haque Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
  • Emily Huang Department of Urology, Houston Methodist Hospital, Houston, TX
  • Jiaqiong Xu Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX
  • Girish S. Kulkarni Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON; Division of Urology, University of Toronto, Toronto, ON
  • Michael Geng School of Engineering Medicine, Texas A&M University, Houston, TX
  • Maryam Anis Department of Urology, Houston Methodist Hospital, Houston, TX
  • Taliah Muhammad Department of Urology, Houston Methodist Hospital, Houston, TX
  • Keith Syson Chan Department of Urology, Houston Methodist Hospital, Houston, TX; Center for TME Spatial Profiling in GU Oncology, Houston Methodist Research Institute, Houston, TX
  • Andrew Farach Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
  • Bin S. Teh Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
  • Brian J. Miles Department of Urology, Houston Methodist Hospital, Houston, TX
  • Zachary Klaassen Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA
  • Guru P. Sonpavde Genitourinary Oncology Program, AdventHealth Cancer Institute, Orlando, FL
  • Christopher J.D. Wallis Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON; Division of Urology, University of Toronto, Toronto, ON; Division of Urology, Mount Sinai Hospital, Toronto, ON
  • Raj Satkunasivam Department of Urology, Houston Methodist Hospital, Houston, TX

DOI:

https://doi.org/10.5489/cuaj.8386

Keywords:

bladder cancer, chemotherapy, radiotherapy, lymph nodes, survival

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 real-world 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.

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Published

2023-10-23

How to Cite

Riveros, C., Ranganathan, S., Haque, W., Huang, E., Xu, J., Kulkarni, G. S., Geng, M., Anis, M., Muhammad, T., Chan, K., Farach, A., Teh, B. S., Miles, B. J., Klaassen, Z., Sonpavde, G. P. ., Wallis, C., & Satkunasivam, R. (2023). Comparative real-world survival outcomes of muscle-invasive bladder cancer treated with bladder-only vs. whole-pelvis concurrent chemoradiation. Canadian Urological Association Journal, 18(2), 17–24. https://doi.org/10.5489/cuaj.8386

Issue

Vol. 18 No. 2 (2024): CUAJ February

Section

Original Research

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