Non-Surgical Bladder-Sparing Multimodal Management in Organ-Confined Urothelial Carcinoma of the Urinary Bladder: A Population-Based Analysis

Autor: Mario de Angelis, Andrea Baudo, Carolin Siech, Letizia Maria Ippolita Jannello, Francesco Di Bello, Jordan A. Goyal, Zhe Tian, Nicola Longo, Ottavio de Cobelli, Felix K. H. Chun, Fred Saad, Shahrokh F. Shariat, Luca Carmignani, Giorgio Gandaglia, Marco Moschini, Francesco Montorsi, Alberto Briganti, Pierre I. Karakiewicz
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Cancers, Vol 16, Iss 7, p 1292 (2024)
Druh dokumentu: article
ISSN: 2072-6694
DOI: 10.3390/cancers16071292
Popis: Background: Trimodal therapy is considered the most validated bladder-sparing treatment in patients with organ-confined urothelial carcinoma of the urinary bladder (T2N0M0). However, scarce evidence exists regarding cancer-specific mortality (CSM) differences between trimodal therapy and other non-extirpative multimodal treatment options such as radiotherapy alone after transurethral resection (TURBT + RT) or chemotherapy alone after transurethral resection (TURBT + CT). Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified T2N0M0 patients treated with either trimodal therapy, TURBT + CT, or TURBT + RT. Temporal trends described trimodal therapy vs. TUBRT + CT vs. TURBT + RT use over time. Survival analyses consisting of Kaplan–Meier plots and multivariable Cox regression (MCR) models addressed CSM according to each treatment modality. Results: 3729 (40%) patients underwent TMT vs. 4030 (43%) TURBT + CT vs. 1599 (17%) TURBT + RT. Over time, trimodal therapy use (Estimating annual percent change, EAPC: +1.2%, p = 0.01) and TURBT + CT use increased (EAPC: +1.5%, p = 0.01). In MCR models, relative to trimodal therapy, TURBT + CT exhibited 1-14-fold higher CSM and TURBT + RT 1.68-fold higher CSM. In a subgroup analysis, TURBT + RT was associated with 1.42-fold higher CSM than TURBT + CT (p < 0.001). Conclusions: Strict trimodal therapy that includes both CT and RT after TURBT offers the best cancer control. When strict trimodal therapy cannot be delivered, cancer-specific survival outcomes appear to be superior with TURBT + chemotherapy compared to TURBT + RT.
Databáze: Directory of Open Access Journals
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