Which treatment is best for patients with AJCC stage IV bladder cancer?
- 24 Downloads
We sought to identify the method that could obtain the best survival rate for AJCC stage IV bladder cancer (BCa) patients.
Patients with AJCC stage IV BCa diagnosed between 2004 and 2015 were identified using the Surveillance, epidemiology and end results (SEER) database. Kaplan–Meier curves and log-rank test were used for overall survival (OS) and cancer-specific survival (CSS). Multivariable Cox regression was used to determine factors associated with all-cause mortality (ACM) and cancer-specific mortality (CSM).
We found that among the 11824 patients, the number of patients who received chemotherapy (CT), radiotherapy (RT) and radical cystectomy (RC) was 6243 (52.8%), 2005 (17.0%) and 4987 (42.2%), respectively. Patients who received CT or RC had improved OS (26.4% vs. 11.7%, p < 0.001 and 27.3% vs. 13.7%, p < 0.001, respectively), but patients who underwent RT alone had lower OS (14.4% vs. 20.5%, p < 0.001). Furthermore, CT combined with RC was associated with the lowest ACM (hazard ratio (HR) = 0.26, 95% CI 0.24–0.28, p < 0.001) and the lowest CSM (HR = 0.24, 95% CI 0.22–0.26, p < 0.001). Patients who only received RT had the highest ACM (HR = 0.84, 95% CI 0.77–0.92, p < 0.001) and the highest CSM (HR = 0.85, 95% CI 0.77–0.94, p = 0.002).
We concluded that CT combined with RC was the best method with the highest survival rate for patients with AJCC stage IV BCa and that CT combined with RC had more benefits in improving OS and CSS than did RT alone.
KeywordsBladder cancer Radical cystectomy Chemotherapy Radiotherapy SEER
Surveillance, epidemiology and end results
American joint committee on cancer
The authors are grateful for the invaluable support and useful discussions with other members of the urology department.
WM, JF and JG were involved in the study conception and design. WM collected and assembled data. WM, BM, XH, SG, ML and JG were involved in data analysis and interpretation WM wrote the manuscript.
This work was supported by grants from the National Natural Science Foundation of China (81001134) and Tongji University (1501219143) to Jiang Geng.
Compliance with ethical standards
Conflict of interest
The authors of this manuscript have no conflicts of interest.
No ethics approval was required as this study was an economic analysis without human subjects.
- 7.Abdollah F, Gandaglia G, Thuret R, Schmitges J, Tian Z, Jeldres C, Passoni NM, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI, Sun M (2013) Incidence, survival and mortality rates of stage-specific bladder cancer in United States: a trend analysis. Cancer Epidemiol 37(3):219–225. https://doi.org/10.1016/j.canep.2013.02.002 CrossRefGoogle Scholar
- 10.Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, Clark PE, Downs TM, Efstathiou JA, Flaig TW, Friedlander T, Greenberg RE, Guru KA, Hahn N, Herr HW, Hoimes C, Inman BA, Jimbo M, Kader AK, Lele SM, Meeks JJ, Michalski J, Montgomery JS, Pagliaro LC, Pal SK, Patterson A, Plimack ER, Pohar KS, Porter MP, Preston MA, Sexton WJ, Siefker-Radtke AO, Sonpavde G, Tward J, Wile G, Dwyer MA, Gurski LA (2017) Bladder cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15(10):1240–1267. https://doi.org/10.6004/jnccn.2017.0156 CrossRefGoogle Scholar
- 16.Richards KA, Kader AK, Otto R, Pettus JA, Smith JJ 3rd, Hemal AK (2012) Is robot-assisted radical cystectomy justified in the elderly? A comparison of robotic versus open radical cystectomy for bladder cancer in elderly ≥75 years old. J Endourol 26(10):1301–1306. https://doi.org/10.1089/end.2012.0035 CrossRefGoogle Scholar
- 19.Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, Coleman JA, Mathew S, Vickers A, Schnorr GC, Feuerstein MA, Rapkin B, Parra RO, Herr HW, Laudone VP (2015) Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol 67(6):1042–1050. https://doi.org/10.1016/j.eururo.2014.11.043 CrossRefGoogle Scholar
- 20.Hu JC, Chughtai B, O’Malley P, Halpern JA, Mao J, Scherr DS, Hershman DL, Wright JD, Sedrakyan A (2016) Perioperative outcomes, health care costs, and survival after robotic-assisted versus open radical cystectomy: a national comparative effectiveness study. Eur Urol 70(1):195–202. https://doi.org/10.1016/j.eururo.2016.03.028 CrossRefGoogle Scholar
- 24.Loehrer Sr. PJ, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I, Raghavan D, Stuart-Harris R, Sarosdy MF, Lowe BA et al (1992) A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10(7):1066–1073. https://doi.org/10.1200/JCO.19188.8.131.526 CrossRefGoogle Scholar
- 25.von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, Bodrogi I, Albers P, Knuth A, Lippert CM, Kerbrat P, Sanchez Rovira P, Wersall P, Cleall SP, Roychowdhury DF, Tomlin I, Visseren-Grul CM, Conte PF (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18(17):3068–3077. https://doi.org/10.1200/JCO.2000.18.17.3068 CrossRefGoogle Scholar
- 27.Dash A, Pettus JA, Herr HW, Bochner BH, Dalbagni G, Donat SM, Russo P, Boyle MG, Milowsky MI, Bajorin DF (2008) A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder: a retrospective experience. Cancer 113(9):2471–2477. https://doi.org/10.1002/cncr.23848 CrossRefGoogle Scholar
- 29.Diaz DA, Pollack A, Reis IM, Mahmoud O, Gonzalgo ML, Ishkanian A, Fernandez G, Manoharan M, Abramowitz MC (2015) Neoadjuvant radiotherapy improves survival in patients with T2b/T3 bladder cancer: a population-based analysis. Clin Genitourin Cancer 13(4):378–384 e371. https://doi.org/10.1016/j.clgc.2015.02.014 CrossRefGoogle Scholar