Comparative effectiveness of radical cystectomy versus bladder-sparing treatment for muscle-invasive urothelial carcinoma: A population-based report.

334 Background: Radical cystectomy (RC) represents the standard of care for patients with muscle-invasive urothelial carcinoma of the urinary bladder (UCUB). Alternative organ-conserving treatments such as chemotherapy and/or radiotherapy have gained interest. We sought to compare survival outcomes of patients according to treatment modalities, in a stage-for-stage analysis. Methods: We relied on the Surveillance, Epidemiology, and End Results Medicare-linked database to identify 12,950 patients diagnosed with T2–T4a N0/x M0 UCUB between years 1992 and 2009. Treatment types include RC (n=5207), chemotherapy/radiation (n=2,669), and surveillance (n=5,074). Following instrumental variable analysis, Cox- and competing-risks regression analyses were performed for prediction of overall survival (OS) and cancer-specific mortality (CSM), respectively. All analyses were stratified according to disease stage (T2, T3, T4a). Results: After adjusting for potential confounders, OS was more favorable for RC relative to chemotherapy/radiation (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.02–2.40) or surveillance (HR: 1.82, 95% CI: 1.20–2.78) in patients with T2 UCUB. For the same stage, CSM rates were lower in the surgery group compared to chemotherapy/radiation (HR: 2.05, 95% CI: 1.14–3.67) or surveillance (HR: 1.95, 95% CI: 1.09–3.48). When analyses focused on individuals with more advanced disease (T3–T4a), no statistically significant difference was observed between chemotherapy/radiation relative to RC for both OS and CSM. Conclusions: In the current retrospective population-based cohort, RC was associated with improved survival outcomes relative to its alternative treatment counterparts. However, this effect was only observable in patients with T2 disease. Conversely, no difference between chemotherapy/radiation vs. surgery was noted in patients with more advanced disease stage.

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736 Radical cystectomy versus bladder-sparing treatment for patients with muscle-invasive urothelial carcinoma of the urinary bladder: A comparative effectiveness population-based study

European Urology Supplements ◽

10.1016/s1569-9056(15)60728-x ◽

2015 ◽

Vol 14 (2) ◽

pp. e736

Author(s):

M. Sun ◽

A. Larcher ◽

M. McCormack ◽

Z. Tian ◽

L. Valiquette ◽

...

Keyword(s):

Urinary Bladder ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Comparative Effectiveness ◽

Population Based ◽

Population Based Study ◽

Muscle Invasive ◽

Bladder Sparing

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Effect of variant histology presence and squamous differentiation on oncological results and patient’s survival after radical cystectomy

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.172 ◽

2018 ◽

Vol 90 (3) ◽

pp. 172-175 ◽

Cited By ~ 2

Author(s):

Ertugrul Sefik ◽

Serdar Celik ◽

Ismail Basmaci ◽

Serkan Yarımoglu ◽

Ibrahim Halil Bozkurt ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Cancer Patients ◽

Radical Cystectomy ◽

Urothelial Cancer ◽

Squamous Differentiation ◽

Cancer Specific Survival ◽

T Stage ◽

Significant Difference ◽

Variant Histology ◽

Muscle Invasive

Objective: To evaluate the effect of variant histology on pathological and survival findings in patients undergoing radical cystectomy due to muscle invasive bladder cancer. Materials and methods: Data from 146 patients with radical cystectomy performed due to muscle-invasive urothelial carcinoma between January 2006 to November 2016 at our clinic were investigated. The preoperative and postoperative data of patients with variant histology were compared with nonvariant urothelial carcinoma patients. Then of patients with variant histology only those with squamous differentiation (SqD) were compared with nonvariant urothelial carcinoma patients in terms of preoperative, postoperative and survival data. Results: Of the 146 patients, 23 had carcinoma with variant histology. Of these, 17 had SqD, 4 had glandular differentiation, 1 patient had plasmocytoid variant and 1 patient had sarcomatoid variant. In patients with variant histology, postoperative T stage and upstaging was higher, with no difference observed in terms of overall and cancer-specific survival compared with nonvariant urothelial cancer patients. SqD patients were observed to have higher postoperative T stage compared to nonvariant urothelial cancer patients, with no significant difference observed in terms of survival. Conclusions: In cystectomy pathologies, patients with variant histology (especially SqD patients) were observed to have proportionally higher T stage compared to nonvariant urothelial carcinoma; however there were no significant differences for overall survival and cancer-specific survival.

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