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Trimodal therapy and radical cystectomy yield similar outcomes in MIBC
Trimodal therapy yields similar oncological outcomes to radical cystectomy for patients with muscle-invasive bladder cancer (MIBC), according to a study published in . Lancet Oncology.
The researchers found that cancer-specific survival, metastasis-free survival, and disease-free survival were similar in patients who underwent triple therapy and those who underwent radical cystectomy. However, overall survival was superior with trimodal treatment.
In this retrospective study, the investigators examined data from 722 patients with MIBC who were eligible for both treatment approaches. Between 2005 and 2017, 440 patients underwent radical cystectomy and 282 patients underwent tritherapy.
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The researchers used propensity score matching (PSM) and inverse probability treatment weighting (IPTW) to assess differences in outcomes. In the PSM analysis, the 3:1 matched cohort consisted of 1119 patients, 837 of whom underwent radical cystectomy and 282 of whom received trimodal therapy.
Median follow-up was 4.38 years in the radical cystectomy group and 4.88 years in the triple therapy group.
Five-year metastasis-free survival was 74% in the radical cystectomy group and 75% in the triple therapy group with IPTW (partial distribution hazard ratio) [SHR] 0.89; 95% CI, 0.67–1.20. P. =.40). The rate for both groups with PSM was 74% (SHR, 0.93, 95% CI, 0.71-1.24, 95% CI, 0.71-1.24). P. =.64).
The 5-year cancer-specific survival rate was 81% in the radical cystectomy group and 84% in the triple therapy group with IPTW (SHR, 0.72; 95% CI, 0.50 to 1.04; P. =.071). PSM rates were 83% and 85%, respectively (SHR, 0.73; 95% CI, 0.52–1.02; P. =.057).
Five-year disease-free survival was 73% in the radical cystectomy group and 74% in the triple therapy group with IPTW (SHR, 0.87; 95% CI, 0.65 to 1.16; 95% CI, 0.65 to 1.16; , P. =.35). The proportion of both groups with PSM was 76% (SHR, 0.88, 95% CI, 0.67 to 1.16, 95% CI, 0.67 to 1.16. P. =.37).
Five-year overall survival was 66% in the radical cystectomy group and 73% in the triple therapy group with IPTW (HR, 0.70; 95% CI, 0.53–0.92; P. =.010). PSM rates were 72% and 77%, respectively (HR, 0.75; 95% CI, 0.58–0.97; 95% CI, 0.58–0.97; P. =.0078).
In the triple therapy cohort, conservative cystectomy was performed in 13% of cases, most of which were due to recurrence. The pelvic recurrence rate was 8%. There were no deaths during the 90 days after trimodal treatment.
In the radical cystectomy cohort, a median of 39 lymph nodes were resected, with a positive margin rate of 1% and local recurrence in 3% of patients. The 90-day perioperative mortality rate was 2.5%.
“These results support that trimodal therapy should be offered to all suitable candidates with muscle-invasive disease in an environment of shared multidisciplinary decision-making.” bladder cancer It’s not just patients with significant comorbidities for whom surgery is not an option,” the researchers concluded.
Disclosure: Some study authors have declared affiliations with biotechnology, pharmaceutical, and/or device companies. Please refer to the original reference for a complete list of disclosures.
reference
Zlotta AR, Ballas LK, Niemierko A and others Radical Cystectomy Versus Trimodal Therapy for Muscle-Invasive Bladder Cancer: A Multicenter Propensity Score Matched and Weighted Analysis. lancet oncol. Published online May 12, 2023. doi:10.1016/S1470-2045(23)00170-5
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