Audenet F, et al. - In a large observational cohort reflecting the continuum of practice settings in the US, researchers evaluated the characteristics and outcomes of patients with muscle-invasive bladder cancer (MIBC) treated with transurethral resection (TUR) plus chemotherapy alone. In a subset of patients, long-term survival could be achieved when treated with TUR plus chemotherapy alone for MIBC. To assess the ability of biomarkers to accurately select patients who could be treated with this bladder-sparing strategy, ongoing clinical trials are underway.

Methods

• Within the National Cancer Database (2004-2015), authors identified 1,538 patients treated with TUR plus multi-agent chemotherapy as definitive treatment for cT2-T4aN0M0 urothelial carcinoma of the bladder.
• They included 17,866 patients treated with radical cystectomy ± perioperative chemotherapy for comparison.
• Using multivariable logistic regression, they compared the baseline characteristics between the two groups.
• Using Kaplan-Meier analysis and Cox regression model, treatment outcomes were evaluated.

Results

• Compared to the standard of care, several variables, including patients’ demography (older age, African-American race, prior malignancy, lack of insurance), tumor characteristics (higher cT stage) and facility types (non-academic facilities, lower volume of radical cystectomy) were related to a higher probability of receiving TUR plus chemotherapy for MIBC, upon multivariate analysis.
• As per data, for all patients treated with TUR plus chemotherapy, the 2-year and 5-year survival rates were 49.0% and 32.9% and, limited to patients with cT2 disease, were 52.6% and 36.2%, respectively.