483 656
Platinum Priority – Brief Correspondence
Editorial by Girish S. Kulkarni and Zachary Klaassen on pp. 488–489 of this issue
Comparative Effectiveness of Trimodal Therapy Versus Radical
Cystectomy for Localized Muscle-invasive Urothelial Carcinoma
of the Bladder
Thomas Seisen
a ,Maxine Sun
a ,Stuart R. Lipsitz
a ,Firas Abdollah
b ,Jeffrey J. Leow
a ,Mani Menon
b ,Mark A. Preston
a ,Lauren C. Harshman
c ,Adam S. Kibel
a ,Paul L. Nguyen
d ,Joaquim Bellmunt
c ,Toni K. Choueiri
c ,Quoc-Dien Trinh
a , *a
Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;
b
Center
for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA;
c
Department of Medical Oncology,
Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;
d
Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 8 3 – 4 8 7ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted March 24, 2017
Associate Editor:
Stephen Boorjian
Keywords:
Urinary bladder neoplasms
Cystectomy
Radiotherapy
Drug therapy
Propensity score
Survival
Abstract
Given the lack of randomized evidence comparing trimodal therapy (TMT) to radical
cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB), we
performed an observational cohort study to examine the comparative effectiveness of
these two definitive treatments. Within the National Cancer Data Base (2004–2011),we
identified 1257 (9.8%) and 11 586 (90.2%) patients who received TMT and RC, respec-
tively. Inverse probability of treatment weighting (IPTW)–adjusted Kaplan-Meier anal-
ysis showed that median overall survival (OS) was similar between the TMT (40 mo, 95%
confidence interval [CI] 34–46) and RC groups (43 mo 95% CI 41–45;
p
= 0.3). In IPTW-
adjusted Cox regression analysis with a time-varying covariate, TMT was associated
with a significant adverse impact on long-term OS (hazard ratio 1.37, 95% CI 1.16–1.59;
p
<
0.001). Interaction terms indicated that the adverse treatment effect of TMT versus
RC decreased with age (
p
= 0.004), while there was no significant interactionwith gender
(
p
= 0.6), Charlson comorbidity index (
p
= 0.09) or cT stage (
p
= 0.8). In conclusion, we
found that TMT was generally associated with worse long-term OS compared to RC for
muscle-invasive UCB. However, the survival benefit of RC should be weighed against the
risks of surgery, especially in older patients. These results are preliminary and empha-
size the need for a randomized controlled trial to compare TMT versus RC.
Patient summary:
We examined the comparative effectiveness of trimodal therapy
versus radical cystectomy for muscle-invasive urothelial carcinoma of the bladder. We
found that trimodal therapy was generally associated with worse long-term overall
survival, although theremay be no difference with radical cystectomy in older individuals.
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Division of Urological Surgery, Brigham and Women’s Hospital, 45 Francis
Street, Boston, MA 02115, USA. Tel. +1 617 5257350; Fax: +1 617 5256348.
E-mail address:
qtrinh@bwh.harvard.edu(Q.-D. Trinh).
http://dx.doi.org/10.1016/j.eururo.2017.03.0380302-2838/
#
2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.