Which treatment is best for patients with AJCC stage IV bladder cancer?

• Published in: International urology and nephrology Vol. 51; no. 7; pp. 1145 - 1156
• Main Authors: Mao, WeiPu, Ma, BingWei, Huang, Xin, Gu, SiMin, Luo, Ming, Fan, Jie, Geng, Jiang
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.07.2019; Springer Nature B.V
• Subjects: Antineoplastic Agents - therapeutic use; Bladder cancer; Cancer; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - therapy; Chemotherapy; China - epidemiology; Combined Modality Therapy - methods; Cystectomy - methods; Cystectomy - statistics & numerical data; Epidemiology; Female; Health risk assessment; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neoplasm Staging; Nephrology; Patients; Radiation therapy; Radiotherapy - methods; Radiotherapy - statistics & numerical data; SEER Program - statistics & numerical data; Survival; Survival Analysis; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urology; Urology - Original Paper; China; SEER; Chemotherapy; Radiotherapy; Bladder cancer; Radical cystectomy
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-019-02105-5

Purpose We sought to identify the method that could obtain the best survival rate for AJCC stage IV bladder cancer (BCa) patients. Methods Patients with AJCC stage IV BCa diagnosed between 2004 and 2015 were identified using the Surveillance, epidemiology and end results (SEER) database. Kaplan–Meier curves and log-rank test were used for overall survival (OS) and cancer-specific survival (CSS). Multivariable Cox regression was used to determine factors associated with all-cause mortality (ACM) and cancer-specific mortality (CSM). Results We found that among the 11824 patients, the number of patients who received chemotherapy (CT), radiotherapy (RT) and radical cystectomy (RC) was 6243 (52.8%), 2005 (17.0%) and 4987 (42.2%), respectively. Patients who received CT or RC had improved OS (26.4% vs. 11.7%, p  < 0.001 and 27.3% vs. 13.7%, p  < 0.001, respectively), but patients who underwent RT alone had lower OS (14.4% vs. 20.5%, p  < 0.001). Furthermore, CT combined with RC was associated with the lowest ACM (hazard ratio (HR) = 0.26, 95% CI 0.24–0.28, p  < 0.001) and the lowest CSM (HR = 0.24, 95% CI 0.22–0.26, p  < 0.001). Patients who only received RT had the highest ACM (HR = 0.84, 95% CI 0.77–0.92, p  < 0.001) and the highest CSM (HR = 0.85, 95% CI 0.77–0.94, p  = 0.002). Conclusions We concluded that CT combined with RC was the best method with the highest survival rate for patients with AJCC stage IV BCa and that CT combined with RC had more benefits in improving OS and CSS than did RT alone.