br Clinical Genitourinary Cancer June e br Survival Rates

Clinical Genitourinary Cancer June 2019 - e491
Survival Rates for Definitive and Non-Definitive Therapy of Muscle-Invasive Bladder Cancer
findings may overestimate the survival benefit of DT. Moreover, by grouping all forms of DT, we potentially underestimated the survival benefit of specific treatment approaches, for example neo-adjuvant chemotherapy followed by RC, which was shown to be superior to RC alone in a randomized trial.13 A recent observational study also showed better OS with RC (with or without perioperative chemotherapy) relative to TMT.9 Consequently, the survival benefit we observed may have been greater had TMT not been included in the DT cohort. Lastly, the NCDB only captures the initial course of treatment, which implies that patients in the nDT group may have undergone RC after initial management of the disease (ie, all methods of treatment administered before disease progression or recurrence). Albeit outside of the scope of our study, it is also important to consider the impact of DT versus nDT on health-related quality of life in the context of muscle-invasive ML385 cancer. Prior to any further intervention, quality of life, additionally to OS, should be fully discussed with the patient.14 For example, recent studies found that continent reconstructions and neobladders for DT might be superior to ileal conduit, with patients reporting better body image and social activity,15-17 despite other studies finding very few, if any, differences.18,19
To summarize, DT was associated with a significant survival benefit, ranging from 15 to 30 months, depending on AJCC stage. This must be weighed against the treatment’s potentially significant morbidity and adverse effects on quality of life.
Clinical Practice Points
RC and TMT are the standard-of-care options for muscle-invasive, localized disease with curative intent (DT).
DT remains underutilized, as patients may be reluctant to un-dergo procedures with significant morbidity and adverse effects on quality of life.
Studies comparing DT with conservative management are lacking.
Among 42,144 patients, DT conferred a significant survival benefit e regardless of disease stage. The receipt of DT was associated with increased odds of survival ranging from 33% to 48% depending on stage at presentation, which translated into a 15- to 30-month overall survival benefit. This survival benefit may help patients and providers put the morbidity and quality of life effects of DT into perspective.
Acknowledgments
Quoc-Dien Trinh is supported by the Brigham Research Insti-tute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Founda-tion of the American Society of Clinical Oncology, a Health Ser-vices Research pilot test grant from the Henry M. Jackson Foundation for the Advancement of Military Medicine, the Clay 
Hamlin Young Investigator Award from the Prostate Cancer Foundation, and an unrestricted educational grant from the Vatti-kuti Urology Institute.
Disclosure
Quoc-Dien Trinh reports consulting fees from Bayer and Astellas. Adam S. Kibel reports consulting fees from Profound, Janssen, and ConfirmMDX. The remaining authors have stated that they have no conflicts of interest.
Supplemental Data
References
2. Seisen T, Sun M, Leow JJ, et al. Efficacy of high-intensity local treatment for metastatic urothelial carcinoma of the bladder: a propensity score-weighted analysis from the National Cancer Data Base. J Clin Oncol 2016; 34:3529-36.
3. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cys-tectomy for patients with bladder cancer using a standardized reporting method-ology. Eur Urol 2009; 55:164-74.