Treatment and survival in non-metastatic muscle invasive bladder cancer: analysis of a national patient cohort.


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Joseph John1,Mohini Varughese2,Nicola Cooper3,Kwok Wong3,Luke Hounsome3,Sarah Treece4,Susan Harden5
1Taunton and Somerset NHS Foundation Trust, Taunton, UK,2Taunton and Somerset NHS Foundation Trust,3National Cancer Registration and Analysis Service, Public Health England,4North West Anglia NHS Foundation Trust,5Cambridge University Hospitals NHS Foundation Trust

Abstract

Background

One third of patients have non-metastatic muscle invasive bladder cancer at diagnosis - an aggressive but potentially curable disease.

Objectives

- To assess the one-year survival of all patients with non-metastatic muscle invasive bladder cancer (T2-4N0M0) in England in 2016, according to treatment modality, disease stage and sex.

- To assess for an association between patient comorbidities and treatment modality for non-metastatic muscle invasive bladder cancer (MIBC).

Method

National cancer registration and analysis service (NCRAS), radiotherapy data sets (RTDS), systemic anti-cancer treatment (SACT) and hospital episode statistics (HES) databases were searched for all patients diagnosed with non-metastatic MIBC in England in 2016. Age and Charlson comorbidity index (CCI) were determined. Treatment modality was ascertained, including radical cystectomy or radiotherapy, the use of neoadjuvant chemotherapy (NAC), and palliative treatment. One-year overall survival was calculated according to treatment group, disease stage and sex.

Results

Non-metastatic MIBC was registered as being diagnosed in 2519 patients. The median age was 76, and the overall one-year net survival was 66% (64 – 68%, 95% confidence interval). Radical treatment was performed in 53% (24% cystectomy, 29% radical radiotherapy). Cystectomy patients received NAC in 37% of cases, compared with 48% of radical radiotherapy patients. Palliative or no active treatment occurred in 47%. Radically treated patients receiving NAC had 8% higher one-year survival compared with radically treated patients not receiving NAC; 91% (88 – 93%) and 83% (80 – 85%) respectively, p = 0.05. Statistically better survival for patients receiving NAC was observed with radical radiotherapy but not with radical cystectomy (p = 0.05). One-year survival was lower for patients receiving palliative intent or no active treatment and was lower in females compared with males, independent of MIBC stage. CCI was recorded as being lower in a higher proportion of patients receiving radical treatment.

Conclusion

One-year survival in non-metastatic MIBC remains low. The superior survival in radically treated patients receiving NAC reflects trial data, and the low penetrance of NAC warrants closer investigation. There is a need to design studies aimed towards improving outcomes for the large patient group who currently receive palliative or no treatment, and for the significantly aged population described.