High-Intensity Local Treatment in Metastatic Urothelial Carcinoma of the Bladder



In a National Cancer Data Base analysis reported in the Journal of Clinical Oncology, Seisen et al found that high-intensity local treatment was associated with an overall survival benefit in patients with metastatic urothelial carcinoma of the bladder. Quoc-Dien Trinh, MD, of Brigham and Women’s Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The study included data from 3,753 patients in the National Cancer Data Base who received multiagent systemic chemotherapy combined with high-intensity vs conservative local treatment. High-intensity treatment was defined as radical cystectomy or ≥ 50 Gy of radiation therapy to the bladder. Inverse probability of treatment weighting–adjusted Kaplan-Meier curves and Cox regression analyses were used to compare overall survival between groups.

Overall, 297 patients (7.9%) received high-intensity and 3,456 (92.1%) received conservative local therapy. On propensity score–weighted analysis, Kaplan-Meier curves showed that median overall survival was 14.92 months (interquartile range = 9.82–30.72 months) in the high-intensity group vs 9.95 months (interquartile range = 5.29–17.08 months) in the conservative group (P < .001). In inverse probability of treatment weighting–adjusted Cox regression analysis, high-intensity local treatment was associated with a significant overall survival benefit (hazard ratio = 0.56, P < .001).

The investigators concluded: “We report an [overall survival] benefit for individuals with [metastatic urothelial carcinoma of the bladder] treated with high-intensity versus conservative [local treatment]. Although the findings are subject to the usual biases related to the observational study design, these preliminary data warrant further consideration in randomized controlled trials, particularly given the poor prognosis associated with [metastatic urothelial carcinoma of the bladder].”

The study was supported by the Vattikuti Urology Institute. ■

Seisen T, et al: J Clin Oncol. June 6, 2016 (early release online).



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