Sicker MIBC patients no more likely to undergo bladder sparing

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Even though patients with muscle-invasive bladder cancer and significant comorbidity are likely to benefit from bladder-sparing treatment approaches, increasing comorbidity burden appears to have no correlation with receiving such treatments.

Researchers from Cedars-Sinai Medical Center in Los Angeles found in a retrospective study that older patients were more likely to receive bladder-sparing therapy, but this trend was not seen in patients with increasing comorbidity.

“Older, sicker patients do not have a higher odds of receiving noncurative or bladder-sparing therapies for muscle-invasive bladder cancer than healthier patients, though they are potentially more likely to benefit from such therapies,” said Devin Patel, MD, a senior resident at Cedars-Sinai working with Timothy Daskivich, MD, and colleagues.

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Current guidelines from the AUA and European Association of Urology recommend that both age and comorbidity are used to direct treatment for muscle-invasive bladder cancer, noted Dr. Patel, who reported the study findings at the AUA annual meeting in San Francisco. He and colleagues hypothesized that providers would be more likely to include patient age than comorbidity in their treatment decision-making.

To analyze the variation in treatment for muscle-invasive bladder cancer by age, comorbidity, and life expectancy, the researchers analyzed a National Cancer Database sample of 19,228 patients with pT2 bladder cancer from 2004 to 2012. Propensity analysis was used to examine utilization of radical cystectomy, curative therapy, and bladder-sparing treatment.

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Results showed that use of radical cystectomy declined with older age but not with comorbidity. In multivariable analysis, patients within increasing age subgroups-aged 60-69 years (OR: 0.89; p=.028), 70-79 (OR: 0.64; p<.001), 80-89 (OR: 0.19; p<.001), and >90 (OR: 0.03;p<.001)-were progressively less likely to undergo radical cystectomy than patients younger than 60 years of age.

However, patients with Charlson Comorbidity Index 1 (CCI 1) (OR: 1.13; p=.001) and CCI 2+ (OR: 0.9; p=.08) were not less likely to receive cystectomy than those with CCI 0. Use of curative therapy showed trends similar to those of radical cystectomy. Bladder-sparing treatment was used infrequently across all age and comorbidity strata, ranging between 7% and 15%, Dr. Patel reported.

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In multivariable analysis, odds of receiving bladder-sparing therapy were significantly higher among patients aged 70-79 (OR: 1.3; p=.006) and 80-89 (OR: 1.9; p<.001) versus those under age 60. The likelihood of undergoing bladder sparing was no different among those patients with CCI 1 (OR: 0.99; p=.8) and CCI 2+ (OR: 1.05; p=.6) compared to those with CCI 0.

“Essentially, comorbidity at diagnosis is poorly associated with treatment for muscle-invasive bladder cancer,” Dr. Patel concluded. “Using life expectancy tools could better stratify patients to more optimally lead to better treatment.”