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Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer

Background: Currently, the diagnosis of non-organ-confined bladder cancer (NOCBCa) has a very poor prognosis. For patients with NOCBCa, treatments such as radical cystectomy (RC) and systemic chemotherapy have shown survival benefits. However, the relative survival benefits of trimodal therapy (TMT)...

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Autores principales: Guo, Yadong, Jie, Xiaoliang, Zhang, Aihong, Zhang, Wentao, Wang, Ruiliang, Zhang, Junfeng, Mao, Shiyu, Wu, Yuan, Wang, Longsheng, Zhang, Ziwei, Yan, Yang, Wang, Ping, Yao, Xudong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909817/
https://www.ncbi.nlm.nih.gov/pubmed/31867271
http://dx.doi.org/10.3389/fonc.2019.01315
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author Guo, Yadong
Jie, Xiaoliang
Zhang, Aihong
Zhang, Wentao
Wang, Ruiliang
Zhang, Junfeng
Mao, Shiyu
Wu, Yuan
Wang, Longsheng
Zhang, Ziwei
Yan, Yang
Wang, Ping
Yao, Xudong
author_facet Guo, Yadong
Jie, Xiaoliang
Zhang, Aihong
Zhang, Wentao
Wang, Ruiliang
Zhang, Junfeng
Mao, Shiyu
Wu, Yuan
Wang, Longsheng
Zhang, Ziwei
Yan, Yang
Wang, Ping
Yao, Xudong
author_sort Guo, Yadong
collection PubMed
description Background: Currently, the diagnosis of non-organ-confined bladder cancer (NOCBCa) has a very poor prognosis. For patients with NOCBCa, treatments such as radical cystectomy (RC) and systemic chemotherapy have shown survival benefits. However, the relative survival benefits of trimodal therapy (TMT) are unclear. Methods: Patients diagnosed with NOCBCa (cT4bN0M0, cTxN1-3M0, or TxNxM1) were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2015). Patients were grouped based on their definitive treatment for bladder cancer (RC or TMT with maximal transurethral resection, chemotherapy, or radiotherapy). All-cause mortality (ACM) and bladder cancer-specific mortality (BCSM) were assessed by Cox proportional hazard regression and competitive risk models. Results: A total of 2,988 patients met the inclusion criteria and were treated with RC (83.5%) or TMT (16.5%). Patients who underwent TMT had higher 5-year ACM (91.3%) and BCSM (88.8%) results compared to patients who underwent RC (82.6 and 75.0%, respectively) (P < 0.001). Adjusted hazard rate (AHR) analysis showed that TMT was associated with higher ACM (AHR: 1.33, 95% CI: 1.15–1.54, P < 0.001) and higher BCSM (AHR: 1.32, 95% CI: 1.13–1.54, P = 0.001). Subgroup analysis revealed not statistically significant between RC and TMT among patients aged ≥80 years (P > 0.05). Conclusions: Compared with TMT, RC is associated with a significant reduction in ACM and BCSM. However, the risks and survival benefits of RC should be weighed, especially in older patients, and our results further suggest that there may be no difference in the prognosis of RC and TMT in patients ≥80 years of age. These results are preliminary and emphasize the need for randomized controlled trials to compare TMT and RC.
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spelling pubmed-69098172019-12-20 Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer Guo, Yadong Jie, Xiaoliang Zhang, Aihong Zhang, Wentao Wang, Ruiliang Zhang, Junfeng Mao, Shiyu Wu, Yuan Wang, Longsheng Zhang, Ziwei Yan, Yang Wang, Ping Yao, Xudong Front Oncol Oncology Background: Currently, the diagnosis of non-organ-confined bladder cancer (NOCBCa) has a very poor prognosis. For patients with NOCBCa, treatments such as radical cystectomy (RC) and systemic chemotherapy have shown survival benefits. However, the relative survival benefits of trimodal therapy (TMT) are unclear. Methods: Patients diagnosed with NOCBCa (cT4bN0M0, cTxN1-3M0, or TxNxM1) were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2015). Patients were grouped based on their definitive treatment for bladder cancer (RC or TMT with maximal transurethral resection, chemotherapy, or radiotherapy). All-cause mortality (ACM) and bladder cancer-specific mortality (BCSM) were assessed by Cox proportional hazard regression and competitive risk models. Results: A total of 2,988 patients met the inclusion criteria and were treated with RC (83.5%) or TMT (16.5%). Patients who underwent TMT had higher 5-year ACM (91.3%) and BCSM (88.8%) results compared to patients who underwent RC (82.6 and 75.0%, respectively) (P < 0.001). Adjusted hazard rate (AHR) analysis showed that TMT was associated with higher ACM (AHR: 1.33, 95% CI: 1.15–1.54, P < 0.001) and higher BCSM (AHR: 1.32, 95% CI: 1.13–1.54, P = 0.001). Subgroup analysis revealed not statistically significant between RC and TMT among patients aged ≥80 years (P > 0.05). Conclusions: Compared with TMT, RC is associated with a significant reduction in ACM and BCSM. However, the risks and survival benefits of RC should be weighed, especially in older patients, and our results further suggest that there may be no difference in the prognosis of RC and TMT in patients ≥80 years of age. These results are preliminary and emphasize the need for randomized controlled trials to compare TMT and RC. Frontiers Media S.A. 2019-12-06 /pmc/articles/PMC6909817/ /pubmed/31867271 http://dx.doi.org/10.3389/fonc.2019.01315 Text en Copyright © 2019 Guo, Jie, Zhang, Zhang, Wang, Zhang, Mao, Wu, Wang, Zhang, Yan, Wang and Yao. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Guo, Yadong
Jie, Xiaoliang
Zhang, Aihong
Zhang, Wentao
Wang, Ruiliang
Zhang, Junfeng
Mao, Shiyu
Wu, Yuan
Wang, Longsheng
Zhang, Ziwei
Yan, Yang
Wang, Ping
Yao, Xudong
Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title_full Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title_fullStr Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title_full_unstemmed Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title_short Evaluation of Survival Outcomes With Trimodal Therapy as Primary Therapy for Non-organ-confined Bladder Cancer
title_sort evaluation of survival outcomes with trimodal therapy as primary therapy for non-organ-confined bladder cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909817/
https://www.ncbi.nlm.nih.gov/pubmed/31867271
http://dx.doi.org/10.3389/fonc.2019.01315
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