Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer
Purpose: Radical cystectomy (RC) with neoadjuvant chemotherapy is the most commonly recommended treatment for muscle-invasive bladder cancer (MIBC), yet RC with urinary diversion remains an invasive treatment. Although some patients with MIBC gain good cancer control with radiation therapy (RT), its...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-05-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422002639 |
| _version_ | 1811176450829582336 |
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| author | Yoshiyuki Yamamoto, MD, PhD Atsunari Kawashima, MD, PhD Toshitaka Morishima, MD, PhD Toshihiro Uemura, MD Akinaru Yamamoto, MD Gaku Yamamichi, MD Eisuke Tomiyama, MD Makoto Matsushita, MD, PhD Taigo Kato, MD, PhD Koji Hatano, MD, PhD Isao Miyashiro, MD, PhD Norio Nonomura, MD, PhD |
| author_facet | Yoshiyuki Yamamoto, MD, PhD Atsunari Kawashima, MD, PhD Toshitaka Morishima, MD, PhD Toshihiro Uemura, MD Akinaru Yamamoto, MD Gaku Yamamichi, MD Eisuke Tomiyama, MD Makoto Matsushita, MD, PhD Taigo Kato, MD, PhD Koji Hatano, MD, PhD Isao Miyashiro, MD, PhD Norio Nonomura, MD, PhD |
| author_sort | Yoshiyuki Yamamoto, MD, PhD |
| collection | DOAJ |
| description | Purpose: Radical cystectomy (RC) with neoadjuvant chemotherapy is the most commonly recommended treatment for muscle-invasive bladder cancer (MIBC), yet RC with urinary diversion remains an invasive treatment. Although some patients with MIBC gain good cancer control with radiation therapy (RT), its effectiveness remains under discussion. Therefore, we aimed to reveal the effectiveness of RT compared with RC for MIBC. Methods and Materials: Using cancer registry and administrative data from 31 hospitals in our prefecture, we recruited patients with bladder cancer (BC) initially registered between January 2013 and December 2015. All patients received RC or RT, and none had metastases. Prognostic factors for overall survival (OS) were analyzed by Cox proportional hazards model and log-rank test. Propensity score matching between the RC and RT groups was performed to examine the association of each factor with OS. Results: Among the patients with BC, 241 received RC and 92 received RT. Median ages of the patients receiving RC and RT were 71.0 and 76.5 years, respectively. Five-year OS rates were 44.8% for patients receiving RC and 27.6% for patients receiving RT (P < .001). Multivariate analysis for OS showed that older age, poorer functional disability, clinical node positive, and pathology of nonurothelial carcinoma were significantly associated with worse prognosis. A propensity score-matching model identified 77 patients with RC and 77 with RT. In this arranged cohort, there were no significant differences in OS between the RC and RT groups (P = .982). Conclusions: Prognostic analysis with matched characteristics showed that patients with BC receiving RT were not significantly different from those receiving RC. These findings could contribute to proper treatment strategies for MIBC. |
| first_indexed | 2024-04-10T19:51:42Z |
| format | Article |
| id | doaj.art-68cb5efd97ce497ab7e4c579e823a93a |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-10T19:51:42Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-68cb5efd97ce497ab7e4c579e823a93a2023-01-28T04:08:00ZengElsevierAdvances in Radiation Oncology2452-10942023-05-0183101157Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder CancerYoshiyuki Yamamoto, MD, PhD0Atsunari Kawashima, MD, PhD1Toshitaka Morishima, MD, PhD2Toshihiro Uemura, MD3Akinaru Yamamoto, MD4Gaku Yamamichi, MD5Eisuke Tomiyama, MD6Makoto Matsushita, MD, PhD7Taigo Kato, MD, PhD8Koji Hatano, MD, PhD9Isao Miyashiro, MD, PhD10Norio Nonomura, MD, PhD11Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan; Department of Urology, Osaka International Cancer Institute, Osaka, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, Japan; Corresponding author: Atsunari Kawashima, MD, PhDCancer Control Center, Osaka International Cancer Institute, Osaka, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanCancer Control Center, Osaka International Cancer Institute, Osaka, JapanDepartment of Urology, Osaka University Graduate School of Medicine, Suita, JapanPurpose: Radical cystectomy (RC) with neoadjuvant chemotherapy is the most commonly recommended treatment for muscle-invasive bladder cancer (MIBC), yet RC with urinary diversion remains an invasive treatment. Although some patients with MIBC gain good cancer control with radiation therapy (RT), its effectiveness remains under discussion. Therefore, we aimed to reveal the effectiveness of RT compared with RC for MIBC. Methods and Materials: Using cancer registry and administrative data from 31 hospitals in our prefecture, we recruited patients with bladder cancer (BC) initially registered between January 2013 and December 2015. All patients received RC or RT, and none had metastases. Prognostic factors for overall survival (OS) were analyzed by Cox proportional hazards model and log-rank test. Propensity score matching between the RC and RT groups was performed to examine the association of each factor with OS. Results: Among the patients with BC, 241 received RC and 92 received RT. Median ages of the patients receiving RC and RT were 71.0 and 76.5 years, respectively. Five-year OS rates were 44.8% for patients receiving RC and 27.6% for patients receiving RT (P < .001). Multivariate analysis for OS showed that older age, poorer functional disability, clinical node positive, and pathology of nonurothelial carcinoma were significantly associated with worse prognosis. A propensity score-matching model identified 77 patients with RC and 77 with RT. In this arranged cohort, there were no significant differences in OS between the RC and RT groups (P = .982). Conclusions: Prognostic analysis with matched characteristics showed that patients with BC receiving RT were not significantly different from those receiving RC. These findings could contribute to proper treatment strategies for MIBC.http://www.sciencedirect.com/science/article/pii/S2452109422002639 |
| spellingShingle | Yoshiyuki Yamamoto, MD, PhD Atsunari Kawashima, MD, PhD Toshitaka Morishima, MD, PhD Toshihiro Uemura, MD Akinaru Yamamoto, MD Gaku Yamamichi, MD Eisuke Tomiyama, MD Makoto Matsushita, MD, PhD Taigo Kato, MD, PhD Koji Hatano, MD, PhD Isao Miyashiro, MD, PhD Norio Nonomura, MD, PhD Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer Advances in Radiation Oncology |
| title | Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer |
| title_full | Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer |
| title_fullStr | Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer |
| title_full_unstemmed | Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer |
| title_short | Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer |
| title_sort | comparative effectiveness of radiation versus radical cystectomy for localized muscle invasive bladder cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422002639 |
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