Disease-free survival of patients with muscle invasive bladder cancer treated with radical cystectomy versus bladder preserving therapy: a nationwide study
Menée à l'aide de données d'un registre néerlandais portant sur 1 432 patients atteints d'un cancer de la vessie non métastatique infiltrant le muscle (durée médiane de suivi : 39 mois), cette étude compare la survie sans maladie à 2 ans après une cystectomie radicale et après une traitement préservant la vessie
Background: Although level I evidence is lacking that radical cystectomy (RC) is superior to bladder preserving therapy (BPT), RC is still advocated as the recommended treatment in patients with non-metastatic muscle invasive bladder cancer (MIBC). We sought to compare the survival of patients with MIBC treated with BPT versus those treated with RC. Methods: All patients diagnosed with non-metastatic MIBC were identified via the population-based Netherlands Cancer Registry. Only patients treated with BPT or RC were included. The primary endpoint was 2-year disease-free survival (DFS), defined as time from start of treatment until loco-regional recurrence, distant metastasis, or death. The secondary endpoint was overall survival (OS). We used inverse propensity treatment weighting (IPTW) based on propensity scores to adjust for baseline differences between treatment groups. Survival was analysed with Kaplan-Meier and Cox proportional hazard models. Results: A total of 1432 patients were included, of whom 1101 underwent RC and 331 BPT. Median follow-up was 39 months (range: 27-51 months). The IPTW adjusted 2-year DFS was 61.5% (95%CI 53.5-69.6%) with BPT and 55.3% (95%CI 51.6-59.1%) with RC, with an adjusted HR 0.84 (95%CI 0.69-1.05). The adjusted 2-year OS for patients treated with BPT versus RC was 74.0% (95%CI 67.0-80.9%) versus 66.0% (95%CI 62.7-68.8%) respectively, with an adjusted HR of 0.80 (95%CI 0.64-0.98). Conclusions: There was no statistically significant difference between the 2-year DFS of patients treated with BPT and RC. We propose that both RC and BPT should be offered as a curative treatment option to eligible patients with non-metastasized MIBC.
International Journal of Radiation Oncology, Biology, Physics 2023