Survival outcomes of patients with bladder cancer and lymph node metastases: Analysis based on a large oncology registry.

Abstract

e16573 Background: Bladder cancer with lymph node metastases (BCLM) is associated with poor overall survival (OS). The management of patients with BCLM is not well defined due to lack of prospective data on multi-modal therapies, but guidelines suggest systemic therapy alone (ST) or concurrent chemoradiation (CCR) in select patients. This study used data from a large national dataset to better understand survival outcomes based on treatment approaches in patients with BCLM. Methods: This retrospective study queried the national cancer database (NCDB) from 2004 to 2020 and followed STROBE guidelines. The primary analytic cohort included patients diagnosed with BCLM based on the TNM stage (Any T, N1-N3, M0). Treatment modalities comprised perioperative systemic therapy combined with definitive surgery (PST), CCR, surgery only (S), ST, and Radiation therapy alone (RT). This study utilized Kaplan-Meier survival analysis and cox proportional hazard analysis to study survival outcomes based on treatment approaches. Results: The study included 5117 patients with BCLM. The analysis revealed that 721 (14.09%) patients with BCLM received PST, 682 (13.33%) received CCR, 280 (5.47%) underwent surgery, 3,085 (60.29%) received ST only, and 349 (6.82%) had RT only. The median OS was 31.7 months (CI: 27.4–39.2, P <0.001) with PST, 15.1 months (CI: 13.5–17.5) with CCR, 13.0 months (CI: 10.9–15.0) with surgery, 18.7 months (CI: 17.9–19.9) with ST, and 6.8 months (CI: 5.9–7.7) with RT. In the multivariate cox analysis, patients who received perioperative systemic therapy along with definitive surgery demonstrated 49% reduced mortality (HR 0.51, 95% CI: 0.43–0.60, P < 0.001) compared to those who underwent surgery only. Conclusions: Treatment approaches with systemic therapy combined with definitive surgery had better oncologic outcomes compared to other treatment modalities, highlighting the significance of a multimodal approach for patients with bladder cancer and lymph node metastases. Cox proportional hazard model in patients with bladder cancer with lymph node metastases. Categories HR (95% CI) P-value Age  <65 years Reference  >= 65 years 0.95 (0.87, 1.03) 0.202 Gender  Men Reference  Women 1.23 (1.14, 1.32) <0.001 Treatment Approaches  Surgery only Reference  CCR 0.89 (0.77, 1.05) 0.16  PST 0.51 (0.43, 0.60) <0.001  ST 0.77 (0.67, 0.88) <0.001  RT 1.85 (1.55, 2.19) <0.001 Race  White Reference  Black 1.08 (0.97, 1.22) 0.16  Others 0.79 (0.63, 1.00) 0.05 Distance to Hospital  < 50 miles Reference  >= 50 miles 0.94 (0.84, 1.04) 0.24 Histology  Urothelial Reference  Non-Urothelial 1.32 (1.20, 1.45) <0.001 Facility  Academic Reference  Non-Academic 1.17 (1.09, 1.26) <0.001 Income Quartiles  < $46,277 Reference  $46,277 - $74,062 0.99 (0.90, 1.08) 0.78  $74,063 + 0.89 (0.80, 0.99) 0.02 Insurance Status  Uninsured Reference  Govt 1.21 (0.99, 1.49) 0.06  Private 1.03 (0.84, 1.26) 0.80 Grade  Well/Moderately differentiated Reference  Poor/undifferentiated 1.04 (0.90, 1.21) 0.58 Area Type  Metro Reference  Urban 1.03 (0.93, 1.14) 0.55  Rural 1.16 (0.92, 1.46) 0.22 Comorbidity status  Charlson-Deyo Score = 0 Reference  >= 1 1.15 (1.08, 1.24) <0.001