Treatment Patterns and Radical Cystectomy Outcomes in Patients Diagnosed With Urothelial Nonmetastatic Muscle-Invasive Bladder Cancer in the United States

Purpose

To characterize trends and patterns in treatment characteristics and perioperative outcomes of patients with urothelial muscle-invasive bladder cancer (MIBC).

Materials and Methods

We utilized the National Cancer Database to assess trends and patterns in treatment modalities (radical cystectomy [RC] with or without neoadjuvant/adjuvant treatments, trimodal bladder-sparing treatment [trimodal treatment], and others) among MIBC patients diagnosed between 2004 and 2017. We also assessed trends and patterns of short-term post-surgery outcomes, including 30-day and 90-day mortality, and readmissions.

Results

Among 83,259 MIBC patients, those who received RC, trimodal treatment, and transurethral resection of bladder tumor (TURBT) plus chemotherapy were 34,715 (41.7%), 7,372 (8.9%), and 6,171 (7.4%), respectively. A substantial proportion (29,314; 35.2%) of MIBC patients received other treatments, including TURBT-only. From 2004 through 2017, the proportion of MIBC patients who utilized guideline-recommended treatments, whether RC (from 36.4% to 42.8%) or trimodal treatment (from 7.9% to 10.2%), increased. Among those who received RC, there was a substantial increase in neoadjuvant chemotherapy (NAC) utilization, from 7.8% to 29.4%. Conversely, utilization of RC without perioperative treatments decreased from 62.3% to 32.7%. There was a significant decrease in 30-day (2.8%–1.8%) and 90-day (7.1%–5.3%) mortality rates among RC recipients.

Conclusion

There was a shift in treatment modalities for MIBC, with increased utilization of RC with NAC. A decrease in post-surgery mortality rates may indicate improved outcomes, although the unmet need for NAC utilization requires further investigation.