Trends in Treatment Patterns and Outcomes Among Patients Diagnosed With Nonmuscle-Invasive Bladder Cancer in the United States

Abstract

Introduction

Heterogeneity in disease presentation in nonmuscle invasive bladder cancer (NMIBC) creates significant variability in treatment patterns and outcomes across risk and clinical subgroups.

Methods

A descriptive analysis of NMIBC patients diagnosed between 2004 and 2017 using the National Cancer Database (NCDB), examined trends and patterns in treatment practices, postradical cystectomy (RC) outcomes, and survival overall and by subgroups. The American Urological Association/Society of Urologic Oncology risk stratification guideline was used to categorize patients into low-intermediate (LIR) and high-risk groups.

Results

Among newly diagnosed NMIBC patients (N = 324,646), 78.6% received TURBT without BCG, and 17.4% received BCG as part of their first course of treatment. Treatment patterns differed by risk groups. The high-risk group had lower TURBT without BCG than LIR (64.7% vs. 90.8%), but higher BCG (28.3% vs. 8.0%) and RC (5.5% vs. 0.5%). In the high-risk group, BCG and RC rates were higher in cT1/cTs than cTa patients. Over time, from 2004-2008 to 2013-2017, the use of BCG (12.6%-21.3%) and RC (2.2%-3.0%) increased, while TURBT-without BCG (84.3%-74.5%) decreased. Post-RC 90-day mortality was higher in high-risk than in LIR patients (4.6% vs. 2.8%). Five-year survival probabilities were unchanged over time. A post-hoc analysis revealed that 14% of patients received postoperative intravesical chemotherapy, with no notable differences in patient characteristics between this subgroup and the overall population.

Conclusion

Unmet medical needs for NMIBC patients persist, as many high-risk patients do not receive guideline-recommended care, and survival outcomes remain largely unchanged.