Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: A systematic review of clinical trials |
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Institution: | 1. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;4. Department of Urology, University of Naples Federico II, Naples, Italy;5. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;7. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;8. Department of Urology, University of Jordan, Amman, Jordan;9. Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Colombia, Canada;10. Department of Urology, McGill University Health Centre, Montréal, Québec, Canada |
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Abstract: | BackgroundRadical cystectomy (RC) represents the mainstay of treatment in patients with muscle-invasive urinary bladder cancer but how it compares with the best organ preservation approach is not known.Materials and methodsThe objective of our review is to compare the 5-year overall survival (OS) rates from retrospective and prospective studies of RC and trimodality treatment (TMT), i.e. concurrent delivery of chemotherapy and radiotherapy after a transurethral resection of bladder tumor (TURBT), involving a total of 10,265 and 3131 patients, respectively. We used random-effect models to pool outcomes across studies and compared event rates of combined outcomes for TMT and RC using an interaction test.ResultsThe median 5-year OS rate was 57% in the TMT group, when compared with 52% (P = 0.04), 51% (P = 0.02) and 53% (P = 0.38) in the whole group receiving RC or the group treated with RC alone or RC + chemotherapy, respectively. The hazard risk (HR) of mortality of patients treated with TMT or RC was 1.22 (95% CI = 1.13–1.32) with an absolute benefit of 5% in favor of the former. The HR of mortality from TMT persisted significantly better not only versus the group treated with RC alone (HR = 1.22; 95% CI = 1.12–1.32), but also versus the group receiving RC + chemotherapy (HR = 1.22; 95% CI = 1.09–1.36). Multivariate analysis confirmed TMT as a significant prognostic variable for both RC alone and RC + chemotherapy.ConclusionCompared with RC, TMT seems to be associated with a better outcome for patients with muscle-invasive bladder cancer (MIBC). The addition of chemotherapy may improve the RC outcome in some subgroups of patients with a higher probability of micrometastases. Prospective randomized trials are urged to verify these findings and better define the role of organ preservation and radical treatment strategy in the management of patients with MIBC. |
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Keywords: | Muscle-invasive bladder cancer Trimodality treatment Radical cystectomy Chemoradiation Bladder-sparing |
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