Matthew D Galsky1, Kristian Stensland2, John P Sfakianos2, Reza Mehrazin2, Michael Diefenbach2, Nihal Mohamed2, Che-Kai Tsao2, Paolo Boffetta2, Peter Wiklund2, William K Oh2, Madhu Mazumdar2, Bart Ferket2. 1. Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden. matthew.galsky@mssm.edu. 2. Matthew D. Galsky, John P. Sfakianos, Reza Mehrazin, Nihal Mohamed, Che-Kai Tsao, Paolo Boffetta, Peter Wiklund, William K. Oh, Madhu Mazumdar, and Bart Ferket, Icahn School of Medicine at Mount Sinai, New York; and Michael Diefenbach, Northwell Health, Great Neck, NY; Kristian Stensland, Lahey Clinic, Burlington, MA; and Peter Wiklund, Karolinska Institute, Stockholm Sweden.
Abstract
PURPOSE: Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. METHODS: We included cTanyN1-3M0 bladder cancer patients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. RESULTS: Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. CONCLUSION: A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.
PURPOSE:Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. METHODS: We included cTanyN1-3M0 bladder cancerpatients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. RESULTS: Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. CONCLUSION: A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.
Authors: Philip L Ho; Daniel L Willis; Jeevitha Patil; Lianchun Xiao; Stephen B Williams; Jonathan J Melquist; Karen Tart; Sahil Parikh; Jay B Shah; Scott E Delacroix; Neema Navai; Arlene Siefker-Radtke; Colin P Dinney; Louis L Pisters; Ashish M Kamat Journal: Urol Oncol Date: 2015-10-01 Impact factor: 3.498
Authors: P M Dodd; J A McCaffrey; H Herr; M Mazumdar; J Bacik; G Higgins; M G Boyle; H I Scher; D F Bajorin Journal: J Clin Oncol Date: 1999-08 Impact factor: 44.544
Authors: Kamran Zargar-Shoshtari; Homayoun Zargar; Yair Lotan; Jay B Shah; Bas W van Rhijn; Siamak Daneshmand; Philippe E Spiess; Peter C Black Journal: J Urol Date: 2015-07-21 Impact factor: 7.450
Authors: Stephen A Boorjian; Simon P Kim; Matthew K Tollefson; Alonso Carrasco; John C Cheville; R Houston Thompson; Prabin Thapa; Igor Frank Journal: J Urol Date: 2013-01-09 Impact factor: 7.450
Authors: Andrea Necchi; Luigi Mariani; Salvatore Lo Vullo; Evan Y Yu; Michael E Woods; Yu-Ning Wong; Lauren C Harshman; Ajjaj Alva; Cora N Sternberg; Aristotelis Bamias; Petros Grivas; Vadim S Koshkin; Florian Roghmann; Jakub Dobruch; Bernie J Eigl; Lucia Nappi; Matthew I Milowsky; Guenter Niegisch; Sumanta K Pal; Ugo De Giorgi; Federica Recine; Ulka Vaishampayan; Dominik D Berthold; Daniel W Bowles; Jack Baniel; Christine Theodore; Sylvain Ladoire; Sandy Srinivas; Neeraj Agarwal; Simon Crabb; Srikala Sridhar; Ali-Reza Golshayan; Carsten Ohlmann; Evanguelos Xylinas; Thomas Powles; Johnathan E Rosenberg; Joaquim Bellmunt; Bas van Rhijn; Matthew D Galsky; Kees Hendricksen Journal: Eur Urol Focus Date: 2017-06-03
Authors: Marco Moschini; Agostino Mattei; Julian Cornelius; Shahrokh F Shariat; Paolo Dell'Oglio; Emanuele Zaffuto; Andrea Salonia; Francesco Montorsi; Alberto Briganti; Renzo Colombo; Andrea Gallina Journal: World J Urol Date: 2018-01-24 Impact factor: 4.226
Authors: Roger Li; Janet E Baack Kukreja; Mohamed A Seif; Firas G Petros; Matthew T Campbell; Justin V Nguyen; Graciela M Nogueras González; Ashish M Kamat; Louis L Pisters; Colin P Dinney; Neema Navai Journal: World J Urol Date: 2019-03-12 Impact factor: 4.226
Authors: Melisa L Wong; Timothy L McMurry; Jessica R Schumacher; Chung-Yuan Hu; George J Stukenborg; Amanda B Francescatti; Caprice C Greenberg; George J Chang; Daniel P McKellar; Louise C Walter; Benjamin D Kozower Journal: J Oncol Pract Date: 2018-09-12 Impact factor: 3.840
Authors: Chana Weinstock; Matthew D Galsky; Elaine Chang; Andrea B Apolo; Rick Bangs; Stephanie Chisolm; Vinay Duddalwar; Jason A Efstathiou; Kirsten B Goldberg; Donna E Hansel; Ashish M Kamat; Paul G Kluetz; Seth P Lerner; Elizabeth Plimack; Tatiana Prowell; Harpreet Singh; Daniel Suzman; Evan Y Yu; Hui Zhang; Julia A Beaver; Richard Pazdur Journal: Nat Rev Urol Date: 2021-09-10 Impact factor: 14.432