Radical Cystectomy Versus Trimodality Therapy in Patients with Muscle-Invasive Bladder Cancer

A report presented at the “Potpourri of Hot Topics in Urothelial Carcinoma” general session at the 2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, noted that prior trials comparing bladder preservation to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) were closed early due to lack of accrual. Alexandre R. Zlotta, MD, PhD, and collaborators compared matched cohorts evaluating trimodality therapy (TMT; maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) and RC, and found that TMT was effective for select patients with MIBC.

In order to meet the inclusion criteria for the retrospective analysis, all patients had to have been eligible for both treatments, with disease characterized by solitary tumors less than seven centimeters, no or unilateral hydronephrosis, and no multifocal carcinoma in situ. Logistic regressions were used to calculate treatment propensity scores. The primary outcome was metastasis-free survival, while other outcomes of interest included overall survival (OS), cancer-specific survival (CSS), distant failure-free survival, and pelvic nodal failure-free survival.

The 3:1 matched cohort included 1,116 patients, of which 834 received RC and 282 received TMT, with similar age, clinical stage, presence of hydronephrosis, and use of (neo)adjuvant chemotherapy. At the five-year mark, “metastasis-free (73 vs 78%, p = 0.07), distant failure-free (78 vs 82%, p = 0.14), and pelvic nodal failure-free (96 vs 94%, p = 0.33) survival were not statistically different between RC and TMT,” however, the authors reported that CSS and OS results favored TMT (78 vs.85%; p = 0.02; and 70 vs. 78%; p <0.001).

The multi-center analysis was designed to provide the “best evidence to date” of RC versus TMT in patients with MIBC, and, ultimately, the authors concluded that “oncologic outcomes seem to be equivalent between TMT and RC, affirming the position that TMT should be offered as an effective alternative.”

Conference Link:  https://meetings.asco.org/2022-asco-genitourinary-cancers-symposium/14112?presentation=205983#205983