Trimodality therapy produces similar oncologic outcomes as radical cystectomy in patients with muscle-invasive bladder cancer (MIBC), according to a study published in The Lancet Oncology.
Researchers found that rates of cancer-specific survival, metastasis-free survival, and disease-free survival were similar in patients who received trimodality therapy and those who received radical cystectomy. However, overall survival was superior with trimodality therapy.
In this retrospective study, the researchers examined data from 722 patients with MIBC who would have been eligible for both treatment approaches. There were 440 patients who underwent radical cystectomy and 282 who were treated with trimodality therapy between 2005 and 2017.
The researchers assessed differences in outcomes using propensity score matching (PSM) and inverse probability treatment weighting (IPTW). In the PSM analysis, the 3:1 matched cohort consisted of 1119 patients — 837 who underwent radical cystectomy and 282 who received trimodality therapy.
The median follow-up was 4.38 years in the radical cystectomy group and 4.88 years in the trimodality therapy group.
The 5-year metastasis-free survival rate was 74% in the radical cystectomy group and 75% in the trimodality therapy group with IPTW (subdistribution hazard ratio [SHR] 0.89; 95% CI, 0.67–1.20; P =.40). The rate was 74% for both groups with PSM (SHR, 0.93; 95% CI, 0.71–1.24; P =.64).
The 5-year cancer-specific survival rate was 81% in the radical cystectomy group and 84% in the trimodality therapy group with IPTW (SHR, 0.72; 95% CI, 0.50–1.04; P =.071). The rates were 83% and 85%, respectively, with PSM (SHR, 0.73; 95% CI, 0.52–1.02; P =.057).
The 5-year disease-free survival rate was 73% in the radical cystectomy group and 74% in the trimodality therapy group with IPTW (SHR, 0.87; 95% CI, 0.65–1.16; P =.35). The rate was 76% for both groups with PSM (SHR, 0.88; 95% CI, 0.67–1.16; P =.37).
The 5-year overall survival rate was 66% in the radical cystectomy group and 73% in the trimodality therapy group with IPTW (HR, 0.70; 95% CI, 0.53–0.92; P =.010). The rates were 72% and 77%, respectively, with PSM (HR, 0.75; 95% CI, 0.58–0.97; P =.0078).
In the trimodality therapy cohort, salvage cystectomy was performed in 13% of cases, mostly due to recurrence. The rate of pelvic recurrence was 8%. There were no deaths in the 90 days after trimodality therapy.
In the radical cystectomy cohort, a median of 39 nodes were removed, the positive margin rate was 1%, and local recurrence was seen in 3% of patients. The 90-day perioperative mortality rate was 2.5%.
“These results support that trimodality therapy, in the setting of multidisciplinary shared decision making, should be offered to all suitable candidates with muscle-invasive bladder cancer and not only to patients with significant comorbidities for whom surgery is not an option,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Zlotta AR, Ballas LK, Niemierko A, et al. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: A multi-institutional propensity score matched and weighted analysis. Lancet Oncol. Published online May 12, 2023. doi:10.1016/S1470-2045(23)00170-5