Treatment trends for muscle-invasive bladder cancer in Germany from 2006 to 2018: Increasing case numbers facilitate more high-volume centers

295 Background: Excellent outcomes with bladder-preserving trimodality therapy have been demonstrated at centers with expertise and high-volume. Some argue that these results may not be replicated at other centers with lower case volumes. We analyzed the National Cancer Database to determine if treatment at a high-volume facility is associated with improved overall survival (OS) for patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) for non-metastatic muscle-invasive bladder cancer (MIBC). Methods: Patients with cT2-4 N0-3 M0 transitional cell MIBC treated with RT or CRT were selected. The case volume variable was derived by calculating a count of patient records by each facility using the entire database of 439,188 patients. Multivariate analysis (MVA) was performed using the Cox proportional hazards model, which was used to assess the association of case volume with OS while controlling for clinicodemographic and treatment factors associated with OS on univariate analysis, including clustering of patients within their treatment facility type. Results: 872 patients treated with radiotherapy from 2008-2012 at 452 unique facilities were identified. 502 (58%) patients received RT, and 370 (42%) patients received CRT. The median case volume at each unique facility was 376 cases with an interquartile range of 235 – 579 cases. In the entire radiotherapy cohort, MVA controlling for patient case load, age, sex, education, T Stage, N Stage, cumulative radiotherapy dose, Charlson-Deyo comorbidity score, and geographic location, demonstrated that treatment at a facility with a higher case volume was associated with improved OS. For every 250 patient increase in facility case volume, the hazard of death at any given time for patients receiving radiotherapy decreased by 7% (HR = 0.93, 95% CI: 0.87 – 0.98, p = .01). Conclusions: To the authors’ knowledge, this is the first analysis demonstrating an association between treatment facility case volume and OS in the treatment of MIBC patients with RT or CRT. Consideration should be given to referring patients to high volume facilities for treatment of MIBC.

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Results of a 2 x 2 Phase III Randomized Trial of Synchronous Chemo-radiotherapy (CRT) Compared to Radiotherapy (RT) Alone and Standard vs. Reduced High Volume RT in Muscle Invasive Bladder Cancer (MIBC) (BC2001 CRUK/01/004)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.048 ◽

2010 ◽

Vol 78 (3) ◽

pp. S2-S3 ◽

Cited By ~ 7

Author(s):

N. James ◽

S. Hussain ◽

E. Hall ◽

P. Jenkins ◽

J. Tremlett ◽

...

Keyword(s):

Bladder Cancer ◽

Randomized Trial ◽

High Volume ◽

Phase Iii ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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Radical cystectomy in muscle invasive bladder cancer: Evolution towards robotic radical cystectomy (experience in a high volume training hospital)

European Urology Supplements ◽

10.1016/s1569-9056(18)33544-9 ◽

2018 ◽

Vol 17 (12) ◽

pp. e2705

Author(s):

M.G. Onaca ◽

H.H.A. Melick ◽

P. Stijns

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

High Volume ◽

Invasive Bladder Cancer ◽

Cancer Evolution ◽

Muscle Invasive Bladder Cancer ◽

Robotic Radical Cystectomy ◽

Muscle Invasive

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Receipt of aggressive therapies for muscle-invasive bladder cancer: Results from the National Cancer Data Base.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.272 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 272-272 ◽

Cited By ~ 1

Author(s):

Phillip J. Gray ◽

Stacey A. Fedewa ◽

William U. Shipley ◽

Jason Alexander Efstathiou ◽

Katherine S. Virgo ◽

...

Keyword(s):

Bladder Cancer ◽

Distant Metastases ◽

High Volume ◽

The United States ◽

Physician Education ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Aggressive Therapy ◽

Cancer Data ◽

Muscle Invasive

272 Background: Over 17,000 patients are diagnosed with muscle-invasive bladder cancer (MIBC) in the United States each year. Despite its lethal potential, emerging data has suggested that many patients do not receive aggressive therapy consistent with established practice standards. Using data from American College of Surgeons Commission on Cancer accredited facilities, we seek to characterize treatment patterns for patients with MIBC according to demographic, clinical, pathologic and facility variables. Methods: 28,691 adult patients diagnosed with MIBC (stages II-IV), excluding those with T4b tumors or distant metastases between 2004 and 2008 were selected for analyses from the National Cancer Database. Treatments included radical or partial cystectomy +/− chemotherapy (CT), chemoradiotherapy (CRT), radiotherapy (RT) or CT alone and surveillance. Aggressive therapy (AT) was defined as any open surgery or RT with a total dose ≥50 Gy. Determinants of AT were assessed by multivariate generalized estimating equations accounting for facility clustering. Results: 52.5% of patients received AT (45% were treated surgically while 7.5% received CRT or RT), 11.7% received palliative CT or RT, and 25.9% received surveillance only. Receipt of AT decreased significantly with advancing age (OR 0.29 for age >80 vs. 18-59, p<.001). AT was also received less frequently by minorities (OR 0.72 for blacks p<.001), the uninsured (OR 0.72, p<.001), Medicaid-insured patients (OR 0.81, p=.006) and by those patients treated at low-volume centers (OR 0.63 vs. high-volume, p<.001). Receipt of AT increased with more advanced stage (OR 2.33 for stage III vs. stage II, p<.001) and in patients with non-urothelial histology (OR 1.32 and 1.50 for squamous and adenocarcinoma histology respectively, p<.001). Hydronephrosis was associated with decreased use of AT (OR 0.70, p<.001). Conclusions: Aggressive therapies for MIBC are received less frequently by the elderly and those with historically poorer socioeconomic status. These data indicate a significant unmet clinical need for physician education regarding appropriate selection of patients for cystectomy and RT-based bladder sparing therapy.

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