Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer

Abstract

PurposeRadical 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 MIBC patients 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 MaterialsUsing cancer registry and administrative data from 31 hospitals in our prefecture, we recruited bladder cancer (BC) patients 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.ResultsAmong the BC patients, 241 received RC and 92 received RT. Median ages of the RC and RT patients were 71.0 and 76.5 years, respectively. Five-year OS rates were 44.8% for RC patients and 27.6% for RT patients (P<0.001). Multivariate analysis for OS showed that older age, poorer functional disability, clinical node positive, and pathology of non-urothelial 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=0.982).ConclusionPrognostic analysis with matched characteristics showed that BC patients receiving RT were not significantly different from those receiving RC. These findings could contribute to proper treatment strategies for MIBC.

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