When compared with trimodal therapy, radical cystectomy was tied to a significant reduction in all-cause and bladder cancer–specific mortality in patients with non–organ-confined bladder cancer (NOCBC; Front Oncol. 2019;9:1315).

“For patients with NOCBC…, treatments such as radical cystectomy…and systemic chemotherapy have shown survival benefits. However, the relative survival benefits of trimodal therapy…are unclear,” explained Yadong Guo, MD, Shanghai Clinical Medical College, Anhui Medical University, Hefei, China, and colleagues.

Using the SEER database, Dr Guo et al collected data for patients diagnosed with NOCBC (cT4bN0M0, cTxN1-3M0, or TxNxM1) before grouping them based on their definitive bladder cancer treatment (ie, radical cystectomy or trimodal therapy with maximal transurethral resection, chemotherapy, or radiotherapy).

All-cause mortality and bladder cancer-specific mortality were assessed by Cox proportional hazard regression and competitive risk models were used to evaluate all-cause and bladder cancer–specific mortality.

Of 2988 patients included in the study, 83.5% were treated with radical cystectomy and 16.5% received trimodal therapy. Patients who underwent trimodal therapy had higher Rates of 5-year all-cause and bladder cancer–specific mortality were higher among patients who underwent trimodal therapy (91.3% and 88.8%, respectively) versus radical cystectomy (82.6 and 75.0%, respectively; P <.001).

Furthermore, results from an adjusted hazard rate (AHR) analysis demonstrated higher rates of all-cause mortality (AHR, 1.33; 95% CI, 1.15-1.54; P <.001) and bladder cancer–specific mortality (AHR: 1.32; 95% CI, 1.13-1.54; P = .001) in patients who underwent trimodal therapy versus radical cystectomy.

Notably, a subgroup analysis revealed that, among patients aged ≥80 years, the difference was not statistically significant (P >.05).

When compared with trimodal therapy, radical cystectomy was tied to a significant reduction in all-cause and bladder cancer–specific mortality, Dr Guo and colleagues concluded, adding that the risks and survival benefits of radical cystectomy should still be considered, especially in older patients with the disease.—Hina Porcelli