Clinical Research Papers:
Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis
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Yeon Joo Kim1, Sang Jun Byun1, Hanjong Ahn2, Choung-Soo Kim2, Beom-Sik Hong2, Sangjun Yoo2, Jae-Lyun Lee3 and Young Seok Kim1
1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea
2 Urology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea
3 Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea
Young Seok Kim, email:
Keywords: muscle-invasive bladder cancer, radical cystectomy, trimodal therapy, radiotherapy, chemotherapy
Received: July 14, 2016 Accepted: March 15, 2017 Published: March 25, 2017
Although radical cystectomy (RC) is considered as the standard therapy for muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) combining transurethral resection of the tumor with radiotherapy and chemotherapy is increasingly recommended as an alternative approach for bladder preservation. In the absence of randomized trials, we compared the clinical outcomes between RC and TMT using propensity score matching with 50 patients in the RC arm and 29 patients in the TMT arm. With respective median follow-up periods of 23 and 32 months for the RC and TMT groups, 5-year distant metastasis-free survival (58% vs. 67%), overall survival (56% vs. 57%), and cancer-specific survival (69% vs. 63%) rates between the RC and TMT groups, respectively, were similar. However, the 5-year local recurrence-free survival was significantly better in the RC group than in the TMT group (74% vs. 35%). Following TMT, acute grade 3 hematological (n = 2) and late grade 3 genitourinary (n = 1) toxicities were reported. These findings demonstrated that oncological outcomes of TMT were comparable with those of RC, except for poorer local control. Large-scale, randomized trials are warranted to confirm the findings of the present retrospective comparison and to guide toward best treatment options.
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