Pd09-03 inverse probability treatment weighting comparison of radical cystectomy to trimodality therapy for ct2-ct4 muscle invasive bladder cancer

You have accessJournal of UrologyCME1 Apr 2023PD09-03 INVERSE PROBABILITY TREATMENT WEIGHTING COMPARISON OF RADICAL CYSTECTOMY TO TRIMODALITY THERAPY FOR CT2-CT4 MUSCLE INVASIVE BLADDER CANCER Alexandre Zlotta, Leslie Ballas, Andrzej Niemierko, Katherine Lajkosz, Cynthia Kuk, Gus Miranda, Michael Drumm, Andrea Mari, Ethan Thio, Neil Fleshner, Girish Kulkarni, Michael Jewett, Rob Bristow, Charles Catton, Padraig Warde, Alejandro Berlin, Srikala Sridhar, Anne Schuckman, Hooman Djaladat, Adam Feldman, Matthew Wszolek, Douglas Dahl, Richard Lee, Philip Saylor, Marc Michaelson, David Miyamoto, Anthony Zietman, William Shipley, Peter Chung, Sia Daneshmand, and Jason Efstathiou Alexandre ZlottaAlexandre Zlotta More articles by this author , Leslie BallasLeslie Ballas More articles by this author , Andrzej NiemierkoAndrzej Niemierko More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Gus MirandaGus Miranda More articles by this author , Michael DrummMichael Drumm More articles by this author , Andrea MariAndrea Mari More articles by this author , Ethan ThioEthan Thio More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Michael JewettMichael Jewett More articles by this author , Rob BristowRob Bristow More articles by this author , Charles CattonCharles Catton More articles by this author , Padraig WardePadraig Warde More articles by this author , Alejandro BerlinAlejandro Berlin More articles by this author , Srikala SridharSrikala Sridhar More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Douglas DahlDouglas Dahl More articles by this author , Richard LeeRichard Lee More articles by this author , Philip SaylorPhilip Saylor More articles by this author , Marc MichaelsonMarc Michaelson More articles by this author , David MiyamotoDavid Miyamoto More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , William ShipleyWilliam Shipley More articles by this author , Peter ChungPeter Chung More articles by this author , Sia DaneshmandSia Daneshmand More articles by this author , and Jason EfstathiouJason Efstathiou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior randomized controlled trials comparing bladder preservation to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) closed due to lack of accrual. Given that none are foreseen, we aimed to compare trimodality therapy (TMT, maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to radical cystectomy (RC) in weighted cohorts of patients with MIBC who would have been eligible for both procedures and aligned with NRG/RTOG trials’ inclusion criteria (cT2-cT4). METHODS: This retrospective analysis included 722 patients with MIBC clinical stage T2-T4N0M0 MIBC urothelial carcinoma of the bladder (440RC/282TMT) who would have been eligible for both RC and TMT, treated at three university centers between 2005-2017 (Massachusetts General Hospital, Boston; Princess Margaret Cancer Centre, Toronto; and University of Southern California, Los Angeles). All patients had solitary tumors <7cm, no or unilateral hydronephrosis, and no extensive/multifocal carcinoma in situ. Differences in survival outcomes by treatment were evaluated using inverse probability treatment weighting (IPTW), a well-established method in balancing out differences between treatment groups. Doubly robust multivariable Cox and competing risk regression models incorporating both stabilized weights and confounders were fit. Five year survival probabilities were estimated. RESULTS: 30% of all MIBC surgical candidates were also candidates for TMT. Age (70.2 vs 71.3) was not significantly different between RC vs TMT. cT2 stage (82.3 vs 90.4%), presence of hydronephrosis (23.0vs9.6%), and use of (neo)-or adjuvant chemotherapy (40.5vs56.4%) were significantly different between RC and TMT. Salvage cystectomy was performed in 38 (13%) patients treated by TMT. Using IPTW, metastasis-free (74.4 vs. 75.2%, p=0.40) and cancer-specific survival (80.5 vs. 83.5%, p=0.07) were not statistically different between RC and TMT whereas overall survival favored TMT (66.5% vs. 73.4%, p=0.007). Outcomes for RC and TMT were not different among centers (p=0.74 and p=0.64, respectively). Pathological stage in the 440 RC was pT2 in 28.2%, pT3-4 in 44.1% and 25.9% node positive. Median number of nodes removed was 39, soft tissue positive margin rate 1.1%, and perioperative mortality 2.5%. CONCLUSIONS: This large contemporary study demonstrates similar oncologic outcomes between RC and TMT for select cT2-cT4 MIBC patients. These patients should be offered the opportunity to discuss various treatment options. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e240 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Zlotta More articles by this author Leslie Ballas More articles by this author Andrzej Niemierko More articles by this author Katherine Lajkosz More articles by this author Cynthia Kuk More articles by this author Gus Miranda More articles by this author Michael Drumm More articles by this author Andrea Mari More articles by this author Ethan Thio More articles by this author Neil Fleshner More articles by this author Girish Kulkarni More articles by this author Michael Jewett More articles by this author Rob Bristow More articles by this author Charles Catton More articles by this author Padraig Warde More articles by this author Alejandro Berlin More articles by this author Srikala Sridhar More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Adam Feldman More articles by this author Matthew Wszolek More articles by this author Douglas Dahl More articles by this author Richard Lee More articles by this author Philip Saylor More articles by this author Marc Michaelson More articles by this author David Miyamoto More articles by this author Anthony Zietman More articles by this author William Shipley More articles by this author Peter Chung More articles by this author Sia Daneshmand More articles by this author Jason Efstathiou More articles by this author Expand All Advertisement PDF downloadLoading ...