Propensity score matched survival analysis of octogenarians with muscle-invasive bladder cancer: chemoradiation compared to radical cystectomy

Radical cystectomy (RC) is an effective curative treatment option for muscle-invasive bladder cancer (MIBC). However, chemoradiation (CRT) is an evolving bladder preservation protocol alternative to RC. With the increase in life expectancy, it is essential to understand the survival outcomes among octogenarians treated with RC and CRT. In this study, we use the National Cancer Database (NCDB) to compare the survival outcomes between RC and CRT in octogenarians.

We collected the data of patients treated for bladder cancer between 2004 to 2018 from the NCDB. Our primary analytic cohort included patients with MIBC (cT2-T4N0M0). We identified the octogenarians and categorized them into RC and CRT arms. The RC arm included those who received RC. The CRT arm included those who received chemotherapy within 90 days of curative radiation therapy. After 1:1 propensity score matching, overall survival (OS) outcomes were compared between both arms.

Among the octogenarians, the median OS for patients treated with RC was 26.1 months (95% CI, 23.9-28.2), and CRT was 28.7 months (95% CI, 26.8-30.6). Our covariate analyses showed that academic institutions performed more RC (49% RC and 29.7% CRT) and community programs served more CRT (45.7% CRT and 24.2% RC). A multivariate Cox regression analysis showed that the mortality risk increased as the Charlson-Deyo comorbidity score and T stage increased.

Octogenarians treated with RC and CRT had similar OS. As life expectancy increases, it is essential to individualize the treatment strategy based on risk assessment and its potential benefits.