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Published on: February 6, 2019
Real-world outcomes of definitive chemoradiotherapy for bladder cancer: a multi-institutional retrospective study in
Daichi Sugahara1, Keiko Nemoto Murofushi2, Hideomi Yamashita1
1Department of Radiology, The University of Tokyo Hospital,113-8655, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
Objective:
We aimed to evaluate real-world clinical outcomes and prognostic factors of definitive chemoradiotherapy (CRT) for bladder cancer in Japan.
Methods:
Patients with bladder cancer treated with definitive CRT between 2010 and 2023 at seven Japanese institutions were retrospectively analyzed. Overall survival (OS) was estimated using the Kaplan-Meier method, whereas cause-specific survival (CSS) and bladder preservation were analyzed using competing risk methods. Univariable analyses were performed using the log-rank and Gray's tests, and multivariable analyses were performed using Cox and Fine-Gray models with Bayesian Information Criterion-based stepwise selection.
Results:
A total of 175 patients were included. Maximal transurethral resection of the bladder tumor (TUR-Bt) was performed in 55% of patients, and 49% were deemed ineligible for radical cystectomy (RC). The 5-year OS, CSS, and bladder preservation rate were 52% (95% CI, 42-60%), 73% (95% CI, 66-80%), and 69% (95% CI, 61-77%), respectively. In multivariable analyses, poorer performance status remained associated with worse OS (P = .003), whereas advanced clinical T stage was associated with worse CSS (P = .018) and maximal TUR-Bt was associated with improved bladder preservation (P = .024). Although patients ineligible for RC demonstrated inferior OS (P < .001) and CSS (P = .007) in univariable analyses, bladder preservation was comparable to those treated by patient preference.
Conclusions:
This multi-institutional retrospective study demonstrates acceptable real-world outcomes of definitive CRT for bladder cancer in Japan. Patient-related factors influenced OS, whereas tumor burden and local tumor control were associated with CSS and bladder preservation.
