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Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans.

Publication ,  Journal Article
Kumar, A; Cherry, DR; Courtney, PT; Nalawade, V; Kotha, N; Riviere, PJ; Efstathiou, J; McKay, RR; Karim Kader, A; Rose, BS; Stewart, TF
Published in: European urology open science
August 2021

Muscle-invasive bladder cancer (MIBC) remains undertreated despite multiple potentially curative options. Both radical cystectomy (RC) with or without neoadjuvant chemotherapy and trimodal therapy (TMT), including transurethral resection of bladder tumor followed by chemoradiotherapy, are standard treatments.To evaluate real-world clinical outcomes of RC with neoadjuvant chemotherapy (RC-NAC), RC without NAC, TMT with National Comprehensive Cancer Network guideline-preferred radiosensitizing chemotherapy including cisplatin or mitomycin-C and 5-fluorouracil (pTMT), and TMT with nonpreferred chemotherapy (npTMT).US veterans with nonmetastatic MIBC (T2-4aN0-3M0) were studied.Overall mortality (OM) was evaluated with multivariable Cox proportional hazard model. Bladder cancer-specific mortality (BCSM) was evaluated with multivariable Fine-Gray regression. Salvage cystectomy rates were obtained by chart review.Overall 2306 patients were included: 1472 (64%) with RC without NAC, 506 (22%) with RC-NAC, 163 (7%) with pTMT, and 165 (7%) with npTMT. On multivariable analysis, pTMT was associated with similar OM (hazard ratio [HR] 1.19; 95% confidence interval [CI] 0.94-1.50; p = 0.15) and BCSM (HR 1.34; 95% CI 0.99-1.83; p = 0.06) to RC-NAC; npTMT was associated with worse OM (HR 1.30; 95% CI 1.04-1.61; p = 0.02) and BCSM (HR 1.45; 95% CI 1.09-1.94; p = 0.01). RC without NAC was associated with similar OM (HR 1.08; 95% CI 0.95-1.24; p = 0.24) and BCSM (HR 1.02; 95% CI 0.86-1.21; p = 0.79). When stratified by age, among patients ≥65 yr of age, treatment with pTMT was associated with similar OM (HR 1.14; 95% CI 0.87-1.50; p = 0.35) and BCSM (HR 1.11; 95% CI 0.76-1.62; p = 0.60). Among patients <65 yr of age, pTMT was associated with worse OM (HR 1.82; 95% CI 1.14-2.91; p = 0.01) and BCSM (HR 2.51; 95% CI 1.52-4.13; p < 0.01). The 5-yr cumulative incidence of salvage cystectomy in the TMT group was 3.6%.In MIBC, patients receiving pTMT have comparable survival in RC-NAC patients ≥65 yr and inferior survival in RC-NAC patients <65 yr. Salvage cystectomy rates were low.Management of muscle-invasive bladder cancer is a multidisciplinary effort requiring thoughtful discussions with patients about treatment options, including trimodal therapy, which is an effective treatment option.

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Published In

European urology open science

DOI

EISSN

2666-1683

ISSN

2666-1691

Publication Date

August 2021

Volume

30

Start / End Page

1 / 10

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Kumar, A., Cherry, D. R., Courtney, P. T., Nalawade, V., Kotha, N., Riviere, P. J., … Stewart, T. F. (2021). Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans. European Urology Open Science, 30, 1–10. https://doi.org/10.1016/j.euros.2021.05.009
Kumar, Abhishek, Daniel R. Cherry, Patrick T. Courtney, Vinit Nalawade, Nikhil Kotha, Paul J. Riviere, Jason Efstathiou, et al. “Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans.European Urology Open Science 30 (August 2021): 1–10. https://doi.org/10.1016/j.euros.2021.05.009.
Kumar A, Cherry DR, Courtney PT, Nalawade V, Kotha N, Riviere PJ, et al. Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans. European urology open science. 2021 Aug;30:1–10.
Kumar, Abhishek, et al. “Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans.European Urology Open Science, vol. 30, Aug. 2021, pp. 1–10. Epmc, doi:10.1016/j.euros.2021.05.009.
Kumar A, Cherry DR, Courtney PT, Nalawade V, Kotha N, Riviere PJ, Efstathiou J, McKay RR, Karim Kader A, Rose BS, Stewart TF. Outcomes for Muscle-invasive Bladder Cancer with Radical Cystectomy or Trimodal Therapy in US Veterans. European urology open science. 2021 Aug;30:1–10.

Published In

European urology open science

DOI

EISSN

2666-1683

ISSN

2666-1691

Publication Date

August 2021

Volume

30

Start / End Page

1 / 10

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences