The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder.

Abstract

OBJECTIVES:

To test the effect of systemic chemotherapy on cancer-specific mortality (CSM) in patients with adenocarcinoma of the urinary bladder (ADKUB).

MATERIALS AND METHODS:

Within the Surveillance, Epidemiology, and End Results registry (2004 to 2016), we identified patients with localized (T2-3N0M0), regional (T4N0M0/TanyN1-3M0), and metastatic (TanyNanyM1) ADKUB. Temporal trends, Kaplan-Meier plots, and multivariable Cox regression models were used before and after 1:1 propensity score matching and inverse probability of treatment weighting.

RESULTS:

Of 1537 patients with ADKUB, 834 (54.0%), 363 (23.5%), and 340 (22.5%) harbored localized, regional, and metastatic disease, respectively. The rates of chemotherapy use increased in localized (estimated annual percentage change [EAPC]: +2.7%; P=0.03) and regional ADKUB (EAPC: +2.4%; P=0.04). Conversely, chemotherapy rates remained stable in metastatic patients (EAPC: +1.6%; P=0.4). In multivariable Cox regression models, chemotherapy use was associated with lower CSM in metastatic ADKUB (hazard ratio [HR]: 0.5; P=0.003), but not in either localized (HR: 0.8; P=0.2) or in regional ADKUB (HR: 1.0; P=0.9). In metastatic ADKUB, the benefit of chemotherapy on CSM persisted after 1:1 propensity score matching (HR: 0.6; P=0.002) and after inverse probability of treatment weighting (HR: 0.4; P<0.001).

CONCLUSIONS:

Chemotherapy improves survival in metastatic ADKUB. However, only one out of 2 such patients benefit from chemotherapy. In consequence, greater emphasis on chemotherapy use may be warranted in these patients. Conversely, no benefit was identified in localized or regional ADKUB.

• Authors: Stefano Luzzago, Carlotta Palumbo, Giuseppe Rosiello, Angela Pecoraro, Marina Deuker, Francesco A Mistretta, Zhe Tian, Gennaro Musi, Emanuele Montanari, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Ottavio de Cobelli, Pierre I Karakiewicz
• Journal: American journal of clinical oncology (Am J Clin Oncol) Vol. 43 Issue 8 Pg. 567-574 (08 2020) ISSN: 1537-453X [Electronic] United States
• PMID: 32467527 (Publication Type: Journal Article)

Topics

• Adenocarcinoma (drug therapy, mortality, pathology)
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Survival Rate
• Urinary Bladder Neoplasms (drug therapy, mortality, pathology)