Affiliation:
1. Division of Hematology and Oncology, Department of Internal Medicine Chi Mei Medical Center Tainan Taiwan
2. Department of Radiation Oncology Chi Mei Medical Center Tainan Taiwan
3. Department of Medical Research Chi Mei Medical Center Tainan Taiwan
4. Department of Information Management Southern Taiwan University of Science and Technology Tainan Taiwan
5. Department of Pharmacy Chia‐Nan University of Pharmacy and Science Tainan Taiwan
6. School of Medicine, College of Medicine National Sun Yat‐sen University Kaohsiung Taiwan
Abstract
AbstractBackgroundBladder preservation therapy is an alternative to radical cystectomy in patients with muscle‐invasive bladder cancer (MIBC). The purpose of this study is to compare survival outcomes between bladder preservation therapy and radical cystectomy in MIBC patients using an Asian nationwide cancer registry database.MethodsFrom the Taiwan Cancer Registry database and the Taiwan National Health Insurance Research Database, we identified bladder cancer patients from 2008 to 2018. The patients with urothelial carcinoma and clinical stage T2‐T4aN0‐1 M0 were included. Propensity score matching by age, gender, clinical stage, cT classification, and Charlson Comorbidity Index score was used between those receiving bladder preservation therapy or radical cystectomy. Overall survival (OS), cancer‐specific survival (CSS), and disease‐free survival (DFS) were compared using the Kaplan–Meier method. Multivariate Cox regression models were used to determine the predictive factors of OS, CSS, and DFS.ResultsFollowing the propensity score matching, 393 MIBC patients were analyzed, 131 (33.3%) receiving bladder preservation therapy and 262 (66.7%) receiving radical cystectomy. After 5 years of the follow‐up period the overall duration was with a median of 15.6 months. The treatment groups did not differ significantly in OS, CSS, and DFS (p = 0.2681, 0.7208, and 0.3616, respectively). In multivariable Cox regression models, bladder preservation therapy remained non‐inferior to radical cystectomy in OS (adjusted hazard ratio [aHR] 1.08; 95% confidence interval [CI], 0.77–1.50; p = 0.6689), CSS (aHR, 1.06; 95% CI, 0.72–1.57; p = 0.7728), and DFS (aHR, 0.76; 95% CI, 0.46–1.27; p = 0.2929). Additionally, among patients ≥80 years, the use of bladder preservation therapy compared with radical cystectomy resulted in an equivalent OS, CSS and DSS.ConclusionIn Asian populations, bladder preservation therapy yielded similar survival outcomes as radical cystectomy in MIBC patients. Based on the results, it is evident that a multidisciplinary approach and shared decision‐making are recommended for bladder cancer treatment.