Trimodal therapy could offer superior overall survival versus radical cystectomy in certain subsets of patients with bladder cancer, according to a retrospective analysis presented at the 2017 Society of Urologic Oncology annual meeting in Washington.
Although bladder cancer-related mortality was generally higher in patients undergoing trimodal therapy versus radical cystectomy, four subsets of patients had superior overall survival with trimodal therapy in this particular analysis, which was based on Medicare-linked Surveillance, Epidemiology, and End Results (SEER) data from 2004 to 2013.
Interestingly, the subgroups included patients who either had clinically node-positive bladder cancer (cN+) or had high risk of occult lymphadenopathy (≥T3), suggesting that radiation and chemotherapy may benefit those patients, according to presenter Matthew Clements, MD, MS, a fourth-year urology resident at the University of Virginia, Charlottesville.
“With how high the complication rate is with the cystectomy, this may be a better option (for those subsets) and they may actually have improved survival with keeping the bladder in place,” Dr. Clements said in an interview with Urology Times.
The gold standard for invasive bladder cancer remains radical cystectomy with pelvic lymph node dissection, Dr. Clements noted.
However, an increasing body of research is examining the potential role of trimodal therapy, including endoscopic management and chemoradiation, particularly as an option for patients who can’t undergo extirpative surgery.
The SEER data evaluated by Dr. Clements and colleagues included patients 65-90 years of age diagnosed with non-metastatic urothelial carcinoma of the bladder.
Using a Cox proportional hazards model, they compared predicted overall survival for 306 patients receiving trimodal therapy and 5,684 patients undergoing radical cystectomy.
On multivariable analysis, they found trimodal therapy was associated with increased bladder cancer mortality risk, both in the treatment group (hazard ratio [HR]: 1.75; p<.001) and the intent-to-treat group (HR: 1.58; p<.001), according to a poster presentation of the results.