A propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

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A propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic Eur Urol Suppl 2017; 16(3);e1580

Kulkarni G.1, Hermanns T.1, Wei Y.1, Bhindi B.1, Satkunasivam R.1, Athanasopoulos P.1, Bostrom P.1, Kuk C.2, Li K.1, Templeton A.3, Sridhar S.3, Van Der Kwast T.4, Chung P.5, Bristow R.5, Milosevic M.5, Warde P.5, Fleshner N.6, Jewett M.6, Bashir S.7, Zlotta A.8 1

Princess Margaret Cancer Centre, University Health Network, Dept. of Surgery, Toronto, Canada, 2 Mount Sinai Hospital, Dept. of Surgery, Toronto, Canada, 3Princess Margaret Cancer Centre, University Health Network, Dept. of Medical Oncology, Toronto, Canada, 4Toronto General Hospital, University Health Network, Dept. of Pathology, Toronto, Canada, 5Princess Margaret Hospital, University Health Network, Radiation Medicine Program, Toronto, Canada, 6Princess Margaret Cancer Centre, University Health Network, Dept. of Surgery (urology), Toronto, Canada, 7Princess Margaret Cancer Centre, University Health Network, Dept. of Biostatistics, Toronto, Canada, 8Mount Sinai Hospital, Dept. of Surgery (urology), Toronto, Canada INTRODUCTION & OBJECTIVES: Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. While radical cystectomy (RC) is currently viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) has emerged as a valid treatment option. In the absence of randomized studies, we compared the oncological outcomes between patients managed by RC or TMT. MATERIAL & METHODS: Patients seen in our multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2012 were retrospectively reviewed and those who received TMT for MIBC were identified and matched, using propensity scores, to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with cox proportional hazards modeling and competing risk analysis, respectively. RESULTS: 162/248 (65%) patients assessed in the MDBCC had MIBC. After MDBCC review and further imaging, pathological review or additional pathological sampling, 89 (36%) had a change in tumour stage and 83 (33%) had a change in treatment plan. 80 patients opted for bladder-sparing therapy and 49 underwent TMT as primary therapy. We matched 48 TMT with 48 RC patients. Median age was 67.5 years and 29.2% were cT3/cT4. At a median follow up of 3.62 years, there were 19 (39.6%) deaths (7 from BC) in the RC group and 15 (31.3%) deaths (6 from BC) in the TMT group. 5 year DSS was 84.7% and 85.2%, in the RC and TMT groups, respectively (p>0.05). CONCLUSIONS: In the setting of an MDBCC, TMT yielded survival outcomes similar to matched RC patients. Appropriately selected MIBC patients should be offered the opportunity to discuss treatment options including organ-sparing TMT.

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