Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases

There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outc...

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Bibliographic Details
Published in:The Journal of urology Vol. 207; no. 2; p. 302
Main Authors: Mitra, Anirban P, Cai, Jie, Miranda, Gus, Bhanvadia, Sumeet, Quinn, David I, Schuckman, Anne K, Djaladat, Hooman, Daneshmand, Siamak
Format: Journal Article
Language:English
Published: United States 01.02.2022
Subjects:
Academic Medical Centers - statistics & numerical data
Academic Medical Centers - trends
Aged
California - epidemiology
Carcinoma, Transitional Cell - mortality
Carcinoma, Transitional Cell - pathology
Carcinoma, Transitional Cell - therapy
Chemotherapy, Adjuvant - statistics & numerical data
Chemotherapy, Adjuvant - trends
Cystectomy - methods
Cystectomy - statistics & numerical data
Cystectomy - trends
Disease-Free Survival
Female
Humans
Lymph Node Excision - statistics & numerical data
Lymph Node Excision - trends
Male
Middle Aged
Neoadjuvant Therapy - statistics & numerical data
Neoadjuvant Therapy - trends
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - prevention & control
Prospective Studies
Retrospective Studies
Robotic Surgical Procedures - statistics & numerical data
Robotic Surgical Procedures - trends
Urinary Bladder - pathology
Urinary Bladder - surgery
Urinary Bladder Neoplasms - mortality
Urinary Bladder Neoplasms - pathology
Urinary Bladder Neoplasms - therapy
California
cystectomy
urinary bladder neoplasms
neoadjuvant therapy
prognosis
urinary diversion
ISSN:1527-3792, 1527-3792
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Summary:There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outcomes included recurrence-free survival (RFS) and overall survival (OS). Associations were assessed using univariable and multivariable models. In all, 70.9% of cases underwent open RC in the last decade, although trend for robot-assisted RC rose since 2009. While lymphadenectomy template remained consistent, nodal submission changed to anatomical packets in 2002 with increase in yield (p <0.001). Neoadjuvant chemotherapy (NAC) use increased with time with concomitant decrease in adjuvant chemotherapy; this was notable in the last decade (p <0.001) and coincided with improved pT0N0M0 rate (p=0.013). Median 5-year RFS and OS probabilities were 65% and 55%, respectively. Advanced stage, NAC, delay to RC, lymphovascular invasion and positive margins were associated with worse RFS (all, multivariable p <0.001). RFS remained stable over time (p=0.73) but OS improved (5-year probability, 1990-1999 51%, 2010-2018 62%; p=0.019). Among patients with extravesical and/or node-positive disease, those who received NAC had worse outcomes than those who directly underwent RC (p ≤0.001). Despite perioperative and surgical advances, and improved pT0N0M0 rates, there has been no overall change in RFS trend following RC, although OS rates have improved. While patients who are downstaged with NAC derive great benefit, our real-world experience highlights the importance of preemptively identifying NAC nonresponders who may have worse post-RC outcomes.
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ISSN:1527-3792
1527-3792
DOI:10.1097/JU.0000000000002242