Characterization of treatment patterns and outcomes in muscle-invasive bladder cancer patients in Sweden

For patients diagnosed with muscle-invasive bladder cancer (MIBC), prognosis remains poor with high rates of progression and risk for mortality. To better understand the current treatment landscape, this study aims to describe real-world treatment patterns and clinical outcomes for MIBC patients in Sweden.

Using population-based registers and electronic medical records, patients with MIBC (T2-4aN0M0) were identified between January 2016 and December 2020 in the Skåne region in Sweden. Patients with de novo MIBC and those who progressed from high-risk nonmuscle-invasive bladder cancer were included. Treatment patterns, overall survival (OS), metastatic rate, event-free survival (EFS), and bladder-intact EFS (BI-EFS) were described.  Results: Among the 231 MIBC patients identified, 34% received only best supportive care (BSC) primarily due to age and comorbidity. Of the 153 patients who received curative treatment, 84 (55%) underwent radical cystectomy (RC) and 69 (45%) received bladder-sparing treatment. Patients who received bladder-sparing treatment were older, had poorer health status, and more comorbidities. Among RC-treated patients, 5-year OS and EFS were 74% (95% confidence interval [CI]: 61-83%) and 70% (95% CI: 58-79%), respectively. Among patients who received bladder-sparing treatment, 5-year OS and BI-EFS were 52% (95% CI: 38-64%) and 34% (95% CI: 21-48%), respectively.

Old age and high rates of comorbidities among the MIBC patient population meant many patients were ineligible for recommended RC and instead received bladder-sparing treatment or BSC only. High rates of progression and poor survival were observed in both patients undergoing RC and patients who received bladder-sparing treatment.