Presentation Authors: Alberto Martini*, New York, NY, Lotta Renström-Koskela, Ashkan Mortezavi, Abdolfazal Hosseini, Stockholm, Sweden, Reza Mehrazin, Matthew D Galsky, John P Sfakianos, New York, NY, Gunnar Steineck, Göteborg, Sweden, N Peter Wiklund, New York, NY
Introduction: There is a fundamental lack of knowledge regarding patients with muscle-invasive bladder cancer (MIBC) that are left untreated.This is an important point when counseling patients. In an effort to address this void, we leveraged the Stockholm cohort for patients with MIBC who did not receive any additional treatment after TURBT, and compared their outcomes with patients who received treatment with curative intent.
Methods: All patients diagnosed with bladder cancer during 1995-1996 in the Stockholm county were collected in a population based cohort consisting of 735 patients. 126 patients diagnosed with non-metastatic MIBC were identified. Kaplan-Meier and cumulative incidence curves were used to evaluate overall survival (OS) and cancer specific mortality (CSM). A multivariable Cox regression was fitted to predict OS; whereas a competing risks regression was adopted for the prediction of CSM, after accounting for other cause mortality (OCM). Analyses were adjusted for age at diagnosis, sex, clinical stage, tumor stage and treatment (yes vs. no).
Results: Overall, 64 (51%) patients did not receive any treatment because of advanced age or comorbidity, whereas 62 (49%) received treatment with curative intent, as either radical cystectomy: 47 or radiation therapy: 15. For untreated patients, median (IQR) age at diagnosis was 79 (63-83) yrs vs. 69 (63-74) in the treated group (p < 0.001). The median follow-up for survivors was 14.4 yrs; 109 patients died during follow-up, 89 of them experienced CSM. The 5-yr OS rate for untreated patients was 5% (95%CI: 1-12%) vs. 48% (95%CI: 36-60%) of treated patients. Patients not receiving any treatment had a 5-yr cumulative incidence of CSM of 86% (95%CI: 75-94%) vs. 48% (95%CI: 36-60%); the OCM rate in the untreated cohort was 9% (95%CI: 4-18%) figure 1. On multivariable analysis, untreated patients had higher risk to die from any cause (HR:2.63; 95%CI: 1.65,4.19; p < 0.001) and experience CSM (HR:2.05; 95%CI: 1.26,3.34; p=0.004).
Conclusions: Despite the old age and comorbidity of the untreated cohort, the rate of CSM remains high. More than 85% of the untreated MIBC patients succumbed to bladder cancer within five years of diagnosis whereas less than 10% of the patients died from other causes. The appropriateness of treatment should always be discussed, given the extremely poor prognosis of untreated patients.