br Keywords Comparative effectiveness Cystectomy Drug

Keywords: Comparative effectiveness, Cystectomy, Drug therapy, Radiotherapy, Urinary Polybrene neoplasms
Introduction
Muscle-invasive bladder cancer is among the leading causes of cancer-related mortality in the United States (US) and is associated with survival rates that have remained largely stagnant in past de-cades.1 Radical cystectomy (RC) in conjunction with neoadjuvant chemotherapy as well as trimodal therapy (TMT), which consists of
1Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 2Faculty of Medicine, McGill University, Montreal, Quebec, Canada 3Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Address for correspondence: Quoc-Dien Trinh, MD, Assistant Professor Division of Urologic Surgery, Brigham and Women’s Hospital, 45 Francis St, Boston, MA 02115 E-mail contact: [email protected]
transurethral resection (TURBT), radiosensitizing chemotherapy, and local radiation treatment (RT) ( 50 Gy) are the standard-of-care options for muscle-invasive, localized disease with curative intent. In the setting of locally advanced or and metastatic bladder cancer, palliative multi-agent chemotherapy is the standard of care; however, local therapy, such as TURBT, RT (< 50 Gy), or even RC may be offered for disease control. A recent observational study showed that RC may even be associated with a survival benefit in select cases.2 Importantly, patients who opt for RC or TMT face a lengthy course of treatment and recovery, significant morbidity, and adverse effects on quality of life.3-5 These adverse effects must be weighed against the treatment benefits. Unfortunately, despite the radical nature of treatment, overall survival (OS) in bladder cancer is modest at best; even in localized disease, it does not exceed 50% at 5 years.6 Therefore, patients may be reluctant to choose these
Table 1 Descriptive Characteristics of 42,144 Patients With Bladder Cancer, Stratified According to the Receipt of Definitive Versus Non-definitive Therapy, National Cancer Database 2004-2012
Localized Disease, n (%)
Advanced Disease, n (%)
Non-definitive
Non-definitive
Definitive Therapy, Therapy, N [ 19,381 P Value Definitive Therapy, Therapy, N [ 2620 P Value
Gender
Race
CCI
Educationa
Insurance
government
Year of diagnosis
Incomeb
Great circle distancec
Facility type
Facility location
Clinical Genitourinary Cancer June 2019 - e489
Survival Rates for Definitive and Non-Definitive Therapy of Muscle-Invasive Bladder Cancer
Table 1 Continued
Localized Disease, n (%)
Advanced Disease, n (%)
Non-definitive
Non-definitive
Definitive Therapy, Therapy, N [ 19,381 P Value Definitive Therapy, Therapy, N [ 2620 P Value
County type
Clinical T stage
NMIBC e e
cT4b e e
AJCC stage
e
e
e
Clinical N stage
cN0 e e
cNþ e e
Treatment
e
Abbreviations: AJCC ¼ American Joint Committee on Cancer; CCI ¼ Charlson Comorbidity Index; NMIBC ¼ nonemuscle-invasive bladder cancer; RC ¼ radical cystectomy; SD ¼ standard deviation; TMT ¼ trimodal therapy. aEducation: percentage of people in the patient’s Zip code without a high school degree. bMedian household income for patient’s zip code is based on 2000 United States Census data. cDistance from facility was calculated as distance in miles between the patient’s residence and the hospital that reported the case.
morbid interventions. For example, a number of studies have demonstrated that RC remains an underutilized treatment in stage