Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study
Abstract Background Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle‐invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods We...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-05-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2126 |
| _version_ | 1826978789943410688 |
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| author | Christel Häggström Hans Garmo Xavier de Luna Mieke Van Hemelrijck Karin Söderkvist Firas Aljabery Viveka Ströck Abolfazl Hosseini Truls Gårdmark Per‐Uno Malmström Staffan Jahnson Fredrik Liedberg Lars Holmberg |
| author_facet | Christel Häggström Hans Garmo Xavier de Luna Mieke Van Hemelrijck Karin Söderkvist Firas Aljabery Viveka Ströck Abolfazl Hosseini Truls Gårdmark Per‐Uno Malmström Staffan Jahnson Fredrik Liedberg Lars Holmberg |
| author_sort | Christel Häggström |
| collection | DOAJ |
| description | Abstract Background Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle‐invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods We selected patients with muscle‐invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all‐cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period. Results The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5‐1.6). In the “trial population,” all‐cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow‐up, 95% confidence interval −41 to 29. Conclusion(s) Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity‐score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations. |
| first_indexed | 2024-04-24T17:10:41Z |
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| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2025-02-18T05:18:35Z |
| publishDate | 2019-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-865dc58b661e4c619139655d110e05722024-11-15T13:01:04ZengWileyCancer Medicine2045-76342019-05-01852196220410.1002/cam4.2126Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort studyChristel Häggström0Hans Garmo1Xavier de Luna2Mieke Van Hemelrijck3Karin Söderkvist4Firas Aljabery5Viveka Ströck6Abolfazl Hosseini7Truls Gårdmark8Per‐Uno Malmström9Staffan Jahnson10Fredrik Liedberg11Lars Holmberg12Department of Surgical Sciences Uppsala University Uppsala SwedenTranslational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences King's College London London UKDepartment of Statistics, USBE Umeå University Umeå SwedenTranslational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences King's College London London UKDepartment of Radiation Sciences, Oncology Umeå University Umeå SwedenDepartment of Clinical and Experimental Medicine, Division of Urology Linköping University Linköping SwedenDepartment of Urology Sahlgrenska University Hospital Gothenburg SwedenDepartment of Urology Karolinska University Hospital Stockholm SwedenDepartment of Clinical Sciences Danderyd Hospital, Karolinska Institute Stockholm SwedenDepartment of Surgical Sciences Uppsala University Uppsala SwedenDepartment of Clinical and Experimental Medicine, Division of Urology Linköping University Linköping SwedenDepartment of Urology Skåne University Hospital Malmö SwedenDepartment of Surgical Sciences Uppsala University Uppsala SwedenAbstract Background Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle‐invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods We selected patients with muscle‐invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all‐cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period. Results The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5‐1.6). In the “trial population,” all‐cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow‐up, 95% confidence interval −41 to 29. Conclusion(s) Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity‐score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations.https://doi.org/10.1002/cam4.2126bladder cancermuscle‐invasiveradical cystectomyradiotherapyurothelial carcinoma |
| spellingShingle | Christel Häggström Hans Garmo Xavier de Luna Mieke Van Hemelrijck Karin Söderkvist Firas Aljabery Viveka Ströck Abolfazl Hosseini Truls Gårdmark Per‐Uno Malmström Staffan Jahnson Fredrik Liedberg Lars Holmberg Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study Cancer Medicine bladder cancer muscle‐invasive radical cystectomy radiotherapy urothelial carcinoma |
| title | Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study |
| title_full | Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study |
| title_fullStr | Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study |
| title_full_unstemmed | Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study |
| title_short | Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study |
| title_sort | survival after radiotherapy versus radical cystectomy for primary muscle invasive bladder cancer a swedish nationwide population based cohort study |
| topic | bladder cancer muscle‐invasive radical cystectomy radiotherapy urothelial carcinoma |
| url | https://doi.org/10.1002/cam4.2126 |
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