The effect of systemic chemotherapy on survival in patients with localized, regional, or metastatic adenocarcinoma of the urinary bladder

Stefano Luzzago, Carlotta Palumbo, Giuseppe Rosiello, Angela Pecoraro, Marina Deuker, Francesco A. Mistretta, Zhe Tian, Gennaro Musi, Emanuele Montanari, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Ottavio De Cobelli, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives:To test the effect of systemic chemotherapy on cancer-specific mortality (CSM) in patients with adenocarcinoma of the urinary bladder (ADKUB).Materials and Methods:Within the Surveillance, Epidemiology, and End Results registry (2004 to 2016), we identified patients with localized (T2-3N0M0), regional (T4N0M0/TanyN1-3M0), and metastatic (TanyNanyM1) ADKUB. Temporal trends, Kaplan-Meier plots, and multivariable Cox regression models were used before and after 1:1 propensity score matching and inverse probability of treatment weighting.Results:Of 1537 patients with ADKUB, 834 (54.0%), 363 (23.5%), and 340 (22.5%) harbored localized, regional, and metastatic disease, respectively. The rates of chemotherapy use increased in localized (estimated annual percentage change [EAPC]: +2.7%; P=0.03) and regional ADKUB (EAPC: +2.4%; P=0.04). Conversely, chemotherapy rates remained stable in metastatic patients (EAPC: +1.6%; P=0.4). In multivariable Cox regression models, chemotherapy use was associated with lower CSM in metastatic ADKUB (hazard ratio [HR]: 0.5; P=0.003), but not in either localized (HR: 0.8; P=0.2) or in regional ADKUB (HR: 1.0; P=0.9). In metastatic ADKUB, the benefit of chemotherapy on CSM persisted after 1:1 propensity score matching (HR: 0.6; P=0.002) and after inverse probability of treatment weighting (HR: 0.4; P<0.001).Conclusions:Chemotherapy improves survival in metastatic ADKUB. However, only one out of 2 such patients benefit from chemotherapy. In consequence, greater emphasis on chemotherapy use may be warranted in these patients. Conversely, no benefit was identified in localized or regional ADKUB.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume43
Issue number8
DOIs
Publication statusPublished - Aug 1 2020

Keywords

  • adenocarcinoma
  • bladder cancer
  • chemotherapy
  • inverse probability of treatment weighting adjustment
  • propensity score

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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