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Purpose

Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice.

Methods

Data from patients diagnosed with cN+ M0 BCa were collected from participating U.K. oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors.

Results

A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI 1.35-1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR] 0.32, 95% CI 0.23-0.44, P<0.001) compared with receiving palliative treatment. Radically treated patients (n=163) received RC (n=76) or radical dose radiotherapy (RT, n=87); choice of radical treatment showed no association with OS (HR 0.94, 95% CI 0.63-1.41, P=0.76) or PFS (HR 0.74, 95% CI 0.50-1.08; P=0.12) on multivariable analysis.

Conclusion

Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC -- in a patient group with poor survival -- this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.

Read an interview about the study here.