Oncological outcomes of patients with muscle-invasive bladder cancer treated with trimodal strategy: A French multicentric study

Abstract

Purpose

Trimodal therapy, an organ-sparing alternative, may be proposed for selected patients with muscle-invasive bladder cancer instead of radical cystectomy. In this multicentre retrospective study, we aimed to assess the oncological outcomes of patients who had trimodal therapy for a muscle-invasive bladder cancer.

Materials and methods

Seventy-three patients from four centres treated who had trimodal therapy (maximal transurethral resection of bladder tumour and concomitant chemoradiotherapy) for localized muscle-invasive bladder cancer were included. Patients meeting the optimal trimodal therapy eligibility criteria as per the European Association of Urology guidelines were identified. Overall survival, recurrence-free survival and cancer-specific survival were assessed using the Kaplan–Meier method. The cumulative incidence of recurrence was estimated using the Kalbfleisch–Prentice method.

Results

Median overall survival was 27.0 months (95 % confidence interval [CI]: 20.3–58.3 months), 5-years overall-, cancer-specific- and recurrence-free survival rates were 37.5% (95 % CI: 25.5–49.5 %), 60 % (95 % CI: 48.3–72.0 %), and 17.9 % (95 % CI: 9.3–28.8 %), respectively. There was no significant difference in 5-year overall survival and recurrence-free survival between the trimodal therapy-eligible and non-eligible patients (hazard ratio [HR]: 1.38, P = 0.30 and HR: 0.96, P = 0.90, respectively). The univariate analysis did not reveal any significant prognostic factors associated with recurrence-free or overall survival.

Conclusion

Trimodal therapy offers encouraging specific survival, the prognosis remains poor. Our study highlights the low number and high frailty of patients to whom trimodal therapy is offered in clinical practice.