Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database
Purpose: For muscle-invasive bladder cancer, bladder preserving chemoradiotherapy (BPCRT) has shown to be a viable alternative for patients with urothelial carcinoma (UCa). Traditionally bladder cancer with variant histology UCa or other tumors types involving the bladder have worse outcomes and BPC...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-01-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630820300896 |
| _version_ | 1818449155955097600 |
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| author | James Robert Janopaul-Naylor Jim Zhong Yuan Liu Chao Zhang Adeboye O. Osunkoya Shreyas Subhash Joshi Mehmet Asim Bilen Bradley Carthon Omer Kucuk Lindsey Marie Hartsell Joseph Shelton Ashesh B. Jani |
| author_facet | James Robert Janopaul-Naylor Jim Zhong Yuan Liu Chao Zhang Adeboye O. Osunkoya Shreyas Subhash Joshi Mehmet Asim Bilen Bradley Carthon Omer Kucuk Lindsey Marie Hartsell Joseph Shelton Ashesh B. Jani |
| author_sort | James Robert Janopaul-Naylor |
| collection | DOAJ |
| description | Purpose: For muscle-invasive bladder cancer, bladder preserving chemoradiotherapy (BPCRT) has shown to be a viable alternative for patients with urothelial carcinoma (UCa). Traditionally bladder cancer with variant histology UCa or other tumors types involving the bladder have worse outcomes and BPCRT has been contraindicated. However, there is limited high level evidence for this recommendation. Materials/methods: The National Cancer Database (NCDB) was queried for all patients with Bladder cancer treated from 2004 to 2015 restricted to clinical stage T2-4, N0, M0 who had variants of UCa or other tumors types involving the bladder (e.g. adenocarcinoma and squamous cell carcinoma). Only patients treated with definitive intent with either radical cystectomy or BPCRT after maximal transurethral tumor resection were analyzed. Propensity-score matching was used. Results: 356 patients had BPCRT and 2093 patients had definitive surgery for muscle-invasive bladder cancer limited to variants of UCa and other tumors types involving the bladder. On multivariable analysis worse prognosis was associated with age >65 years old (HR 1.24, p = 0.004) and T4 disease (HR 1.90, p < 0.001). In propensity score weighted sample, there was no statistical significant difference in OS for patients with BPCRT as compared to cystectomy (p = 0.387) and for neuroendocrine, micropapillary or not otherwise specified histology subgroups there was no significant difference. Patients with adenocarcinoma (HR 1.75) or squamous cell carcinoma (HR 1.49) had worse OS associated with BPCRT compared to surgery. Conclusion: From 2004 to 2015, BPCRT in muscle-invasive bladder cancer was associated with similar overall survival compared to cystectomy in patients with selected variant histology but with worse OS for adenocarcinoma or squamous cell carcinoma specifically. As our study has inherent limitations, these hypotheses require validation in a prospective setting and/or with a larger sample size. |
| first_indexed | 2024-12-14T20:30:55Z |
| format | Article |
| id | doaj.art-1e85af579fb94ecd921ae759aa66683e |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-12-14T20:30:55Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-1e85af579fb94ecd921ae759aa66683e2022-12-21T22:48:31ZengElsevierClinical and Translational Radiation Oncology2405-63082021-01-01263034Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer DatabaseJames Robert Janopaul-Naylor0Jim Zhong1Yuan Liu2Chao Zhang3Adeboye O. Osunkoya4Shreyas Subhash Joshi5Mehmet Asim Bilen6Bradley Carthon7Omer Kucuk8Lindsey Marie Hartsell9Joseph Shelton10Ashesh B. Jani11Department of Radiation Oncology, Emory University, United States; Corresponding author at: 1365 Clifton Rd NE, Suite A1300, Department of Radiation Oncology, Atlanta, GA 30322, United States.Department of Radiation Oncology, Emory University, United StatesDepartment of Biostatistics and Bioinformatics, Emory University, United StatesDepartment of Biostatistics and Bioinformatics, Emory University, United StatesDepartment of Pathology, Emory University, United States; Department of Urology, Emory University, United StatesDepartment of Urology, Emory University, United StatesDepartment of Hematology and Medical Oncology, Emory University, United StatesDepartment of Hematology and Medical Oncology, Emory University, United StatesDepartment of Hematology and Medical Oncology, Emory University, United StatesDepartment of Urology, Emory University, United StatesDepartment of Radiation Oncology, Emory University, United StatesDepartment of Radiation Oncology, Emory University, United StatesPurpose: For muscle-invasive bladder cancer, bladder preserving chemoradiotherapy (BPCRT) has shown to be a viable alternative for patients with urothelial carcinoma (UCa). Traditionally bladder cancer with variant histology UCa or other tumors types involving the bladder have worse outcomes and BPCRT has been contraindicated. However, there is limited high level evidence for this recommendation. Materials/methods: The National Cancer Database (NCDB) was queried for all patients with Bladder cancer treated from 2004 to 2015 restricted to clinical stage T2-4, N0, M0 who had variants of UCa or other tumors types involving the bladder (e.g. adenocarcinoma and squamous cell carcinoma). Only patients treated with definitive intent with either radical cystectomy or BPCRT after maximal transurethral tumor resection were analyzed. Propensity-score matching was used. Results: 356 patients had BPCRT and 2093 patients had definitive surgery for muscle-invasive bladder cancer limited to variants of UCa and other tumors types involving the bladder. On multivariable analysis worse prognosis was associated with age >65 years old (HR 1.24, p = 0.004) and T4 disease (HR 1.90, p < 0.001). In propensity score weighted sample, there was no statistical significant difference in OS for patients with BPCRT as compared to cystectomy (p = 0.387) and for neuroendocrine, micropapillary or not otherwise specified histology subgroups there was no significant difference. Patients with adenocarcinoma (HR 1.75) or squamous cell carcinoma (HR 1.49) had worse OS associated with BPCRT compared to surgery. Conclusion: From 2004 to 2015, BPCRT in muscle-invasive bladder cancer was associated with similar overall survival compared to cystectomy in patients with selected variant histology but with worse OS for adenocarcinoma or squamous cell carcinoma specifically. As our study has inherent limitations, these hypotheses require validation in a prospective setting and/or with a larger sample size.http://www.sciencedirect.com/science/article/pii/S2405630820300896Bladder cancerChemoradiationSurgeryVariant histologyAdenocarcinomaSquamous cell carcinoma |
| spellingShingle | James Robert Janopaul-Naylor Jim Zhong Yuan Liu Chao Zhang Adeboye O. Osunkoya Shreyas Subhash Joshi Mehmet Asim Bilen Bradley Carthon Omer Kucuk Lindsey Marie Hartsell Joseph Shelton Ashesh B. Jani Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database Clinical and Translational Radiation Oncology Bladder cancer Chemoradiation Surgery Variant histology Adenocarcinoma Squamous cell carcinoma |
| title | Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database |
| title_full | Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database |
| title_fullStr | Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database |
| title_full_unstemmed | Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database |
| title_short | Bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder: An analysis of the National Cancer Database |
| title_sort | bladder preserving chemoradiotherapy compared to surgery for variants of urothelial carcinoma and other tumors types involving the bladder an analysis of the national cancer database |
| topic | Bladder cancer Chemoradiation Surgery Variant histology Adenocarcinoma Squamous cell carcinoma |
| url | http://www.sciencedirect.com/science/article/pii/S2405630820300896 |
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