Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis of over 12,000 patients

Publication date: Available online 13 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Vishal Vashistha, Hanzhang Wang, Andrew Mazzone, Michael A. Liss, Robert S. Svatek, Mary Schleicher, Dharam Kaushik
PurposeRadical cystectomy (RC) has been the mainstay treatment for muscle-invasive bladder cancer (MIBC) while combined modality treatment (CMT-radiation therapy, concurrent chemotherapy and maximal transurethral resection of bladder tumor) is preserved for patients with substantial comorbidities. We performed a comprehensive assessment of overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS), and treatment-related complications between RC and CMT.MethodsWe searched seven databases (PubMed, Scopus, EMBASE, Proquest, CINAHL, and the clinical trials.gov) for randomized-controlled trials (RCTs) and prospective and retrospective studies directly comparing RC with CMT from database inception to March 2016. We conducted meta-analyses evaluating OS, DSS, and PFS with hazard ratios (HR) and 95% confidence intervals (CI).ResultsNineteen studies evaluating 12,380 subjects were selected. For the 8 studies encompassing 9554 subjects eligible for meta-analyses, we found no difference in OS at 5 years (HR: 0.96, favoring CMT, CI [0.72–1.29; p = 0.778]) or 10 years (HR: 1.02, favoring cystectomy, CI [0.73–1.42; p = 0.905]). No difference was observed in DSS at 5 years (HR: 0.83, favoring radiation, CI [0.54–1.28; p = 0.390]) or 10 years (HR: 1.17, favoring cystectomy, CI [0.89–1.55; p = 0.264]), or PFS at 10 years (HR: 0.85, favoring CMT, CI [0.43–1.67; p = 0.639]). The cystectomy arms had higher rates of early major complications while rates of minor complications were similar between the two treatments.ConclusionCurrent meta-analysis reveals no differences in OS, DSS, or PFS between RC and CMT. Further RCTs are necessary to identify the optimal treatment for specific patients.

Teaser

Historically, radical cystectomy has been the mainstay treatment for muscle-invasive bladder cancer while combined modality treatment (radiation therapy, chemotherapy, and maximal resection of bladder tumor) has been preserved for poor surgical candidates. Our systematic review with quantitative syntheses of randomized trials and prospective and retrospective studies suggests cystectomy offers no benefit in survival or disease progression compared to radiation-based management for invasive bladder cancer.


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