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High-intensity local treatments may improve OS in metastatic urothelial bladder cancer
Aggressive local treatment improved OS compared with conservative approaches for patients with metastatic urothelial carcinoma of the bladder, according to the results of an observational study.
Urothelial carcinoma of the bladder accounts for approximately 74,000 new cancer cases and 16,000 deaths per year in the United States, and few improvements have been made in treatment of metastatic diseases since the early 1990s.
Studies of local treatments in other metastatic urologic malignancies have shown benefit, but these techniques have not been studied in patients with metastatic urothelial carcinoma of the bladder.
Quoc-Dien Trinh
Quoc-Dien Trinh, MD, FRCSC, assistant professor of surgery at Harvard Medical School and urologic surgeon at Brigham and Women’s Hospital, and colleagues sought to determine whether high-intensity local treatments — such as radical cystectomy or high-dose ( 50 Gy) radiation therapy delivered to the bladder — would translate to a survival benefit in this patient population.
The researchers accessed the National Cancer Data Base to identify 3,753 patients who received multiagent chemotherapy for bladder cancer between 1998 and 2012.
The researchers stratified patients based on their receipt of high-intensity local therapy (7.91%; n = 297) or conservative local therapy (92.09%; n = 3,456).
The majority of patients in the high-intensity group (83.5%; n = 248) underwent radical cystectomy; the remaining 16.5% (n = 49) had high-dose radiation delivered to the bladder (median dose, 59.4 Gy; range, 50.4-64.8).
In the conservative local treatment group, 68.75% (n = 2,376) had transurethral resection of the bladder and 22.66% (n = 783) had no local treatment. The remaining 8.59% (n = 297) had less than 50 Gy radiation delivered to the bladder.
The researchers performed inverse probability of treatment weighting–scored Kaplan-Meier curve analyses to compare OS in patients based on local treatment platforms.
OS from initial diagnosis served as the study’s primary endpoint.
Median follow-up for the weighted analysis was 64.72 months (interquartile range, 37.59-117.75).
Patients who received high-intensity local treatment achieved significantly prolonged median OS (14.92 months vs. 9.95 months; P < .001). A regression analysis showed that high-intensity therapy correlated with a survival benefit (HR = 0.56; 95% CI, 0.48-0.65).
The researchers acknowledged study limitations, including the potential for selection bias inherent in their observational design and the inclusion of only patients with metastatic disease.
The researchers further acknowledged that they did not have access to several potential confounding factors, including BMI, renal function and cardiovascular disease.
“Although the findings are subject to the usual biases related to the observational study design, these preliminary data warrant randomized controlled trials to explore this question, particularly given the poor prognosis associated with metastatic urothelial carcinoma of the bladder,” Trinh and colleagues wrote. – by Cameron Kelsall
Disclosure: Trinh reports honoraria from Intuitive Surgical. Please see the full study for a list of all other researchers’ relevant financial disclosures.