Treatment Patterns, Disease Recurrence, and Overall Survival in Patients With Muscle-Invasive Bladder Cancer After...

The treatment landscape for muscle-invasive bladder cancer (MIBC) is evolving, and the real-world clinical burden in patients undergoing radical cystectomy (RC) remains poorly characterized. This study evaluated treatment patterns, recurrence, and overall survival (OS) in patients aged ≥ 65 years who underwent RC for MIBC.

Using the SEER-Medicare database (2007-2020), we identified patients with MIBC post-RC. Trends in treatment modality (RC alone [no neoadjuvant or adjuvant therapy], neoadjuvant therapy + RC only, RC + adjuvant therapy only, or both neoadjuvant and adjuvant therapy + RC) were summarized. Recurrence and OS were analyzed using Kaplan-Meier estimates overall and by disease stage (T2N0M0, T3-T4N0M0, T1-T4N1M0) and treatment modality. OS among patients with vs. without recurrence was compared using an adjusted Cox proportional hazards model.

Among 1149 patients with MIBC (60.2% T2N0M0; 31.7% T3-T4N0M0; 8.1% T1-T4N1M0), 53.6% received RC alone; others received neoadjuvant therapy + RC (33.9%), RC + adjuvant therapy (10.2%), or both (2.3%). From 2007-2009 to 2019-2020, the proportion of patients treated with RC alone fell from 77.7% to 33.9% whereas neoadjuvant therapy + RC rose from 9.2% to 61.0%. The overall 5-year recurrence rate was 53.1%, varying by disease stage (T2N0M0: 46.0%, T3-T4N0M0: 61.1%, T1-T4N1M0: 77.7%) and treatment modality (RC alone: 51.4%, neoadjuvant therapy + RC: 47.6%, RC + adjuvant therapy: 69.3%, both: not estimable). The overall 5-year OS rate was 53.0%, varying by disease stage (T2N0M0: 61.3%; T3-T4N0M0: 42.6%; T1-T4N1M0: 33.6%) and treatment modality (RC alone: 48.2%; neoadjuvant therapy +RC: 66.9%, RC + adjuvant therapy: 42.0%, both: 38.0%). Patients with vs. without recurrence had significantly shorter OS (hazard ratio = 1.88, P < .001).

Patients with MIBC post-RC experience high recurrence rates and poor survival outcomes across stages and treatment modalities. Effective strategies to prevent or delay recurrence are urgently needed to improve long-term survival in this population.