Presentation Authors: Osama Alalao*, Catrina Mueller-Leonhard, Providence, RI, Simon P. Kim, Aurora, CO, Ali Amin, Christopher Tucci, Gyan Pareek, Anthony Mega, Dragan Golijanin, Boris Gershman, Providence, RI
Introduction: There are limited data regarding the optimal management of clinically node-positive (cN+) bladder cancer. Although the mainstay of treatment is chemotherapy, it is unclear whether local therapy in the form of radiation versus surgery provides superior oncologic outcomes. We, therefore, examined the comparative effectiveness of chemoradiation versus chemotherapy and radical cystectomy for the management of cN+ bladder cancer.
Methods: We identified adult patients aged 18-69 with Charlson index 0-1 with cTany cN1-3 cM0 urothelial carcinoma of the bladder treated with systemic chemotherapy followed by â‰¥40 cGy radiation therapy (chemo+RT) or systemic chemotherapy followed by radical cystectomy (chemo+RC) from 2004-2014 in the NCDB. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression.
Results: A total of 421 patients were included in the study, of whom 335 underwent chemo+RC and 86 underwent chemo+RT. Compared to patients who underwent chemo+RC, patients who underwent chemo+RT were older (median 62 vs 58 years, p=0.006), had more advanced cN stage (15% vs 6% cN3, 48% vs 44% cN2, and 37% vs 50% cN1, p=0.01), and were less likely to be treated at an academic/research program (41% vs 59%, p < 0.001), although there were no statistically significant differences in cT stage. Of patients who underwent RC, 34% were ypN0 and 10% were ypT0. During a median follow-up of 24.2 (IQR 14.0, 44.0) months, 213 patients died of any cause. In univariable analyses, chemo+RC was associated with improved OS compared to chemo+RT (HR 0.63; p=0.003; Figure). However, on multivariable analysis, chemo+RC was not associated with statistically significantly improved survival (HR 0.87; p=0.44).
Conclusions: In this observational study, there was no statistically significant difference in OS between chemoradiation or chemotherapy and RC among patients with cN+ bladder cancer after multivariable adjustment.