MP72-01 RADICAL CYSTECTOMY VERSUS BLADDER-SPARING TREATMENT FOR PATIENTS WITH MUSCLE-INVASIVE UROTHELIAL CARCINOMA OF THE URINARY BLADDER: A COMPARATIVE EFFECTIVENESS POPULATION-BASED STUDY.

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You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2015MP72-01 RADICAL CYSTECTOMY VERSUS BLADDER-SPARING TREATMENT FOR PATIENTS WITH MUSCLE-INVASIVE UROTHELIAL CARCINOMA OF THE URINARY BLADDER: A COMPARATIVE EFFECTIVENESS POPULATION-BASED STUDY. Maxine Sun, Giorgio Gandaglia, Alessandro Larcher, Michael McCormarck, Shahrokh Shariat, Luc Valiquette, Fred Saad, and Pierre Karakiewicz Maxine SunMaxine Sun More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Michael McCormarckMichael McCormarck More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Luc ValiquetteLuc Valiquette More articles by this author , Fred SaadFred Saad More articles by this author , and Pierre KarakiewiczPierre Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2635AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Muscle-invasive urothelial carcinoma of the urinary bladder (UCUB) is an aggressive disease. The standard treatment of care is radical cystectomy (RC). Trimodal bladder-preserving treatment (BPT), including transurethral resection of the bladder tumor, radiation, and chemotherapy has gained considerable interest. We sought to perform a comparative effectiveness assessment of RC vs. BPT in a stage-for-stage analysis. METHODS We performed a retrospective cohort study of Medicare beneficiaries with non-metastatic muscle-invasive (T2–T4a, N0) UCUB treated with RC or BPT from 1991 to 2009. Following instrumental variable analysis that accounts for both measured and unmeasured confounders, multivariable Cox- and competing-risks regression two-stage residual inclusions models were fitted. All analyses were stratified according to disease stage (organ-confined vs. non-organ confined). Our primary outcomes were overall survival (OS) and cancer-specific mortality (CSM). RESULTS Overall 4168 patients with muscle-invasive UCUB were identified, where 3488 (84%) underwent RC and 680 (16%) received BPT, respectively. During the entire study span, the 5-year OS rates for RC and BPT were 42.9% (95% confidence interval [CI]=41 to 45%) and 21.8% (95% CI=19 to 26%), respectively. Five-year CSM rates were 34.0% (95% CI=32 to 36) and 47.6% (95% CI=44 to 52) for the same groups, respectively. In patients with organ-confined UCUB (T2N0), BPT-treated individuals had significantly increased risks of mortality (hazard ratio [HR]: 1.49, 95% CI=1.04–2.13, P=0.031) and CSM (HR: 1.66, 95% CI=1.03–2.67, P=0.036) compared to RC patients. Among those with non-organ confined UCUB (≥T3N0), no difference was noted with respect to OS (HR: 1.22, 95% CI=0.62–2.40, P=0.571) and CSM (HR: 1.13, 95% CI=0.48–2.64, P=0.780) between the two groups. CONCLUSIONS RC was associated with improved cancer control outcomes compared to BPT in organ-confined UCUB. However, no difference between the two treatment modalities was observed with respect to survival amongst patients with more advanced disease stage. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e921 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxine Sun More articles by this author Giorgio Gandaglia More articles by this author Alessandro Larcher More articles by this author Michael McCormarck More articles by this author Shahrokh Shariat More articles by this author Luc Valiquette More articles by this author Fred Saad More articles by this author Pierre Karakiewicz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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