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

  • Urology - Original Paper
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Abstract

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.

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Abbreviations

CT:

Chemotherapy

RT:

Radiotherapy

RC:

Radical cystectomy

SEER:

Surveillance, epidemiology and end results

OS:

Overall survival

CSS:

Cancer-specific survival

ACM:

All-cause mortality

CSM:

Cancer-specific mortality

BCa:

Bladder cancer

AJCC:

American joint committee on cancer

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Acknowledgements

The authors are grateful for the invaluable support and useful discussions with other members of the urology department.

Author contributions

WM, JF and JG were involved in the study conception and design. WM collected and assembled data. WM, BM, XH, SG, ML and JG were involved in data analysis and interpretation WM wrote the manuscript.

Funding

This work was supported by grants from the National Natural Science Foundation of China (81001134) and Tongji University (1501219143) to Jiang Geng.

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Authors and Affiliations

  1. Department of Urology, Shanghai Tenth People’s Hospital, Tongji University, No. 301, Yanchang Road, Jing’an District, Shanghai, 200072, China

    WeiPu Mao, Xin Huang, SiMin Gu, Ming Luo & Jiang Geng

  2. Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, 200072, China

    BingWei Ma

  3. Department of Pathology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Jie Fan

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  1. WeiPu Mao
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Correspondence to Jie Fan or Jiang Geng.

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Mao, W., Ma, B., Huang, X. et al. Which treatment is best for patients with AJCC stage IV bladder cancer?. Int Urol Nephrol 51, 1145–1156 (2019). https://doi.org/10.1007/s11255-019-02105-5

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