PD27-01 CONTEMPORARY UTILIZATION TRENDS AND SURVIVAL OUTCOMES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND BLADDER PRESERVATION THERAPY FOR MUSCLE INVASIVE BLADDER CANCER

Field: Medicine (Health Sciences)

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2016PD27-01 CONTEMPORARY UTILIZATION TRENDS AND SURVIVAL OUTCOMES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND BLADDER PRESERVATION THERAPY FOR MUSCLE INVASIVE BLADDER CANCER David Cahn, Elizabeth Handorf, Michael Nordsiek, Thomas Churilla, Eric Horwitz, Benjamin Ristau, David Chen, Rosalia Vitebo, Richard Greenberg, Alexander Kutikov, Robert Uzzo, and Marc Smaldone David CahnDavid Cahn More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Michael NordsiekMichael Nordsiek More articles by this author , Thomas ChurillaThomas Churilla More articles by this author , Eric HorwitzEric Horwitz More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViteboRosalia Vitebo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare overall survival (OS) in patients undergoing radical cystectomy (RC) and bladder preservation therapy (BPT) for muscle invasive urothelial carcinoma of the bladder. METHODS We conducted a retrospective, observational cohort study in which we reviewed the National Cancer Database (NCDB) to identify patients with analytic stage II-III (N0M0) urothelial carcinoma of the bladder from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) [50-80Gy], and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. OS was compared between RC and BPT using unadjusted Kaplan Meier curves and Cox regression models adjusted for year of treatment, hospital volume, and patient/tumor characteristics using increasingly stringent selection criteria to identify those undergoing BPT. RESULTS Of the 603,298 patients with bladder cancer captured in the NCDB from 2003-2011, 9% (n=54,518) had analytic stage II-III with urothelial histology. 51.1% (n=27,843) of these patients were treated with RC (70.9%, n=19,745) or BPT (29.1%, n= 8,098). Of the patients undergoing BPT, stratified by selection criteria, 26.9% (n=2,176) and 15.0% (n=1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively. Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, we noted attenuated differences in OS using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29]; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68]). CONCLUSIONS In the NCDB, receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases. However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to compare trimodal BPT to RC to identify optimal candidates for bladder preservation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e649 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Cahn More articles by this author Elizabeth Handorf More articles by this author Michael Nordsiek More articles by this author Thomas Churilla More articles by this author Eric Horwitz More articles by this author Benjamin Ristau More articles by this author David Chen More articles by this author Rosalia Vitebo More articles by this author Richard Greenberg More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...