Stefano Luzzago1,2, Carlotta Palumbo1,3, Giuseppe Rosiello1,4, Angela Pecoraro1,5, Marina Deuker1,6, Zhe Tian1, Shahrokh F Shariat7,8,9,10,11, Fred Saad1, Ottavio de Cobelli2,12, Pierre I Karakiewicz1. 1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 2. Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy. 3. Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy. 4. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy. 6. Department of Urology, University Hospital Frankfurt, Frankfurt, Germany. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 8. Departments of Urology, Weill Cornell Medical College, New York, New York. 9. Department of Urology, University of Texas Southwestern, Dallas, Texas. 10. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 11. Department of Urology, Institute for Urology and Reproductive Health I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 12. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Abstract
BACKGROUND: To test the effect of radical cystectomy (RC) with chemotherapy vs only chemotherapy on overall mortality (OM) in metastatic urothelial carcinoma of the urinary bladder (mUCUB). METHODS: Within the Surveillance, Epidemiology, and End Results registry (2004-2016), we identified patients with mUCUB. Stratification was made according to treatment: RC with chemotherapy vs only chemotherapy. Kaplan-Meier plots and multivariable Cox regression models were used before and after 1:1 propensity score (PS) matching and inverse probability of treatment weighting (IPTW). RESULTS: Of 2414 patients with mUCUB, 500 (21.0%) vs 1914 (79.0%) were treated with RC with chemotherapy vs only chemotherapy, respectively. In multivariable Cox regression models, RC with chemotherapy was associated with lower OM in the overall cohort (hazard ratio [HR], 0.5; P < .001), after 1:1 PS matching (HR, 0.5; P < .001), after IPTW (HR, 0.5; P < .001) and after accounting for number and location of metastases (HR, 0.5; P < .001). However, higher overall survival after RC with chemotherapy was only observed in patients with one metastatic site (21 vs 16 months; P = .001). CONCLUSION: In contemporary patients with mUCUB, RC with chemotherapy is associated with lower OM rates, relative to chemotherapy alone, but only in patients with a single metastatic site. These individuals accounted for the vast majority of patients in whom an RC was performed, despite the presence of metastatic disease.
BACKGROUND: To test the effect of radical cystectomy (RC) with chemotherapy vs only chemotherapy on overall mortality (OM) in metastatic urothelial carcinoma of the urinary bladder (mUCUB). METHODS: Within the Surveillance, Epidemiology, and End Results registry (2004-2016), we identified patients with mUCUB. Stratification was made according to treatment: RC with chemotherapy vs only chemotherapy. Kaplan-Meier plots and multivariable Cox regression models were used before and after 1:1 propensity score (PS) matching and inverse probability of treatment weighting (IPTW). RESULTS: Of 2414 patients with mUCUB, 500 (21.0%) vs 1914 (79.0%) were treated with RC with chemotherapy vs only chemotherapy, respectively. In multivariable Cox regression models, RC with chemotherapy was associated with lower OM in the overall cohort (hazard ratio [HR], 0.5; P < .001), after 1:1 PS matching (HR, 0.5; P < .001), after IPTW (HR, 0.5; P < .001) and after accounting for number and location of metastases (HR, 0.5; P < .001). However, higher overall survival after RC with chemotherapy was only observed in patients with one metastatic site (21 vs 16 months; P = .001). CONCLUSION: In contemporary patients with mUCUB, RC with chemotherapy is associated with lower OM rates, relative to chemotherapy alone, but only in patients with a single metastatic site. These individuals accounted for the vast majority of patients in whom an RC was performed, despite the presence of metastatic disease.
Authors: Gabriele Sorce; Rocco Simone Flammia; Benedikt Hoeh; Francesco Chierigo; Lukas Hohenhorst; Andrea Panunzio; Armando Stabile; Giorgio Gandaglia; Zhe Tian; Derya Tilki; Carlo Terrone; Michele Gallucci; Felix K H Chun; Alessandro Antonelli; Fred Saad; Shahrokh F Shariat; Francesco Montorsi; Alberto Briganti; Pierre I Karakiewicz Journal: Prostate Date: 2022-04-01 Impact factor: 4.012