Bladder-Sparing Trimodal Therapy Improves OS Compared With Radical Therapy

By Emily Menendez - August 9, 2023

Limited data are available to guide the management of patients with clinically node-positive nonmetastatic bladder cancer (cN+ M0 BCa). Researchers from the United Kingdom carried out a multicenter, retrospective analysis of survival outcomes in patients with node-positive disease to gain better insight.

Several oncology centers that offered both bladder-sparing trimodal therapy (TMT) and radical cystectomy (RC) were utilized to collect data from patients diagnosed with cN+ M0 BCa. Overall survival (OS) and progression-free survival (PFS) outcomes were recorded, along with treatment details and clinical factors.

The analysis included 287 patients with cN+ M0 BCa. The median OS was 1.55 years (95% CI, 1.35-1.82). Patients who received radical treatments (n=163), including RC (n=76) or radical dose radiotherapy (n=87) were associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23-0.44; P<.001) compared with palliative treatment. The choice of radical treatment had no association with OS (HR, 0.94; 95% CI, 0.63-1.41; P=.76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P=.12) on multivariable analysis.

Patients with cN+ m0 BCa had similar survival outcomes whether treated with surgery or radical therapy. As RC can result in poor morbidity for patients with an already poor survival rate, this research confirms that TMT should be a treatment option for patients with cN+ M0 BCa.