Neoadjuvant Radiotherapy Improves Survival in Patients with T2b/T3 Bladder Cancer: A Population-Based Analysis

Dayssy Alexandra Diaz, Alan Pollack, Isildinha Reis, Omar Mahmoud, Mark L Gonzalgo, Adrian Ishkanian, Gustavo Fernandez, Murugesan Manoharan, Matthew C Abramowitz

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Neoadjuvant radiotherapy (NART) for muscle-invasive bladder cancer (MIBC) is currently underused. However, the outcomes for MIBC have remained suboptimal. We investigated the relationship of NART to cause-specific mortality (CSM) and overall mortality (OM) among patients with a diagnosis of MIBC. Materials and Methods The patients diagnosed with primary invasive urothelial carcinoma of the bladder from 1983 to 2008 with localized disease were included. Patients aged > 90 years, those diagnosed with T1 or T4 BC, and those with no information on tumor grade were excluded from the analysis. Kaplan-Meier, Cox regression, and competing risk methods were used in the analysis of OM and CSM. Results A total of 5562 patients were included in the cohort (115 NART and 5447 surgery alone). On univariate analysis, NART significantly decreased the OM for patients with high-grade BC (hazard ratio [HR], 0.8), stage T2b (HR, 0.74), and stage T2b/T3 (HR, 0.74). CSM was also lower for those with stage T2b disease (HR, 0.63). Multivariable analysis revealed that NART was associated with a significant decrease in CSM (P =.043) and OM (P =.0462) for those with T2b. Likewise, an improvement was seen in OM (P =.0337) for patients with T2b/T3 who had received NART. Conclusion NART was significantly associated with decreased CSM and OM in patients with clinical T2b/T3 BC and OM for patients with T2b/T3. These data suggest that NART could be beneficial in patients with T2b/T3 BC. In the modern era, the greatest utility would potentially be for patients with an incomplete response to neoadjuvant chemotherapy or as an adjunct to chemotherapy to improve the complete response rates.

Original languageEnglish (US)
Pages (from-to)378-384.e1
JournalClinical Genitourinary Cancer
Volume13
Issue number4
DOIs
StatePublished - Aug 1 2015

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Urinary Bladder Neoplasms
Radiotherapy
Survival
Mortality
Population
Muscles
Drug Therapy
Urinary Bladder
Carcinoma

Keywords

  • Cause-specific mortality
  • Cystectomy
  • Overall mortality
  • SEER
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Neoadjuvant Radiotherapy Improves Survival in Patients with T2b/T3 Bladder Cancer : A Population-Based Analysis. / Diaz, Dayssy Alexandra; Pollack, Alan; Reis, Isildinha; Mahmoud, Omar; Gonzalgo, Mark L; Ishkanian, Adrian; Fernandez, Gustavo; Manoharan, Murugesan; Abramowitz, Matthew C.

In: Clinical Genitourinary Cancer, Vol. 13, No. 4, 01.08.2015, p. 378-384.e1.

Research output: Contribution to journalArticle

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abstract = "Background Neoadjuvant radiotherapy (NART) for muscle-invasive bladder cancer (MIBC) is currently underused. However, the outcomes for MIBC have remained suboptimal. We investigated the relationship of NART to cause-specific mortality (CSM) and overall mortality (OM) among patients with a diagnosis of MIBC. Materials and Methods The patients diagnosed with primary invasive urothelial carcinoma of the bladder from 1983 to 2008 with localized disease were included. Patients aged > 90 years, those diagnosed with T1 or T4 BC, and those with no information on tumor grade were excluded from the analysis. Kaplan-Meier, Cox regression, and competing risk methods were used in the analysis of OM and CSM. Results A total of 5562 patients were included in the cohort (115 NART and 5447 surgery alone). On univariate analysis, NART significantly decreased the OM for patients with high-grade BC (hazard ratio [HR], 0.8), stage T2b (HR, 0.74), and stage T2b/T3 (HR, 0.74). CSM was also lower for those with stage T2b disease (HR, 0.63). Multivariable analysis revealed that NART was associated with a significant decrease in CSM (P =.043) and OM (P =.0462) for those with T2b. Likewise, an improvement was seen in OM (P =.0337) for patients with T2b/T3 who had received NART. Conclusion NART was significantly associated with decreased CSM and OM in patients with clinical T2b/T3 BC and OM for patients with T2b/T3. These data suggest that NART could be beneficial in patients with T2b/T3 BC. In the modern era, the greatest utility would potentially be for patients with an incomplete response to neoadjuvant chemotherapy or as an adjunct to chemotherapy to improve the complete response rates.",
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T1 - Neoadjuvant Radiotherapy Improves Survival in Patients with T2b/T3 Bladder Cancer

T2 - A Population-Based Analysis

AU - Diaz, Dayssy Alexandra

AU - Pollack, Alan

AU - Reis, Isildinha

AU - Mahmoud, Omar

AU - Gonzalgo, Mark L

AU - Ishkanian, Adrian

AU - Fernandez, Gustavo

AU - Manoharan, Murugesan

AU - Abramowitz, Matthew C

PY - 2015/8/1

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N2 - Background Neoadjuvant radiotherapy (NART) for muscle-invasive bladder cancer (MIBC) is currently underused. However, the outcomes for MIBC have remained suboptimal. We investigated the relationship of NART to cause-specific mortality (CSM) and overall mortality (OM) among patients with a diagnosis of MIBC. Materials and Methods The patients diagnosed with primary invasive urothelial carcinoma of the bladder from 1983 to 2008 with localized disease were included. Patients aged > 90 years, those diagnosed with T1 or T4 BC, and those with no information on tumor grade were excluded from the analysis. Kaplan-Meier, Cox regression, and competing risk methods were used in the analysis of OM and CSM. Results A total of 5562 patients were included in the cohort (115 NART and 5447 surgery alone). On univariate analysis, NART significantly decreased the OM for patients with high-grade BC (hazard ratio [HR], 0.8), stage T2b (HR, 0.74), and stage T2b/T3 (HR, 0.74). CSM was also lower for those with stage T2b disease (HR, 0.63). Multivariable analysis revealed that NART was associated with a significant decrease in CSM (P =.043) and OM (P =.0462) for those with T2b. Likewise, an improvement was seen in OM (P =.0337) for patients with T2b/T3 who had received NART. Conclusion NART was significantly associated with decreased CSM and OM in patients with clinical T2b/T3 BC and OM for patients with T2b/T3. These data suggest that NART could be beneficial in patients with T2b/T3 BC. In the modern era, the greatest utility would potentially be for patients with an incomplete response to neoadjuvant chemotherapy or as an adjunct to chemotherapy to improve the complete response rates.

AB - Background Neoadjuvant radiotherapy (NART) for muscle-invasive bladder cancer (MIBC) is currently underused. However, the outcomes for MIBC have remained suboptimal. We investigated the relationship of NART to cause-specific mortality (CSM) and overall mortality (OM) among patients with a diagnosis of MIBC. Materials and Methods The patients diagnosed with primary invasive urothelial carcinoma of the bladder from 1983 to 2008 with localized disease were included. Patients aged > 90 years, those diagnosed with T1 or T4 BC, and those with no information on tumor grade were excluded from the analysis. Kaplan-Meier, Cox regression, and competing risk methods were used in the analysis of OM and CSM. Results A total of 5562 patients were included in the cohort (115 NART and 5447 surgery alone). On univariate analysis, NART significantly decreased the OM for patients with high-grade BC (hazard ratio [HR], 0.8), stage T2b (HR, 0.74), and stage T2b/T3 (HR, 0.74). CSM was also lower for those with stage T2b disease (HR, 0.63). Multivariable analysis revealed that NART was associated with a significant decrease in CSM (P =.043) and OM (P =.0462) for those with T2b. Likewise, an improvement was seen in OM (P =.0337) for patients with T2b/T3 who had received NART. Conclusion NART was significantly associated with decreased CSM and OM in patients with clinical T2b/T3 BC and OM for patients with T2b/T3. These data suggest that NART could be beneficial in patients with T2b/T3 BC. In the modern era, the greatest utility would potentially be for patients with an incomplete response to neoadjuvant chemotherapy or as an adjunct to chemotherapy to improve the complete response rates.

KW - Cause-specific mortality

KW - Cystectomy

KW - Overall mortality

KW - SEER

KW - Surgery

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