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Survival after radiotherapy versus radical cystectomy for primary muscle-invasive bladder cancer : A Swedish nationwide population-based cohort study

Häggström, Christel ; Garmo, Hans ; de Luna, Xavier ; Van Hemelrijck, Mieke ; Söderkvist, Karin ; Aljabery, Firas ; Ströck, Viveka ; Hosseini, Abolfazl ; Gårdmark, Truls and Malmström, Per Uno , et al. (2019) In Cancer Medicine 8(5). p.2196-2204
Abstract

Background: Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle-invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods: We selected patients with muscle-invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all-cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not... (More)

Background: Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle-invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods: We selected patients with muscle-invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all-cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period. Results: The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5-1.6). In the “trial population,” all-cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow-up, 95% confidence interval −41 to 29. Conclusion(s): Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity-score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bladder cancer, muscle-invasive, radical cystectomy, radiotherapy, urothelial carcinoma
in
Cancer Medicine
volume
8
issue
5
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:30938068
  • scopus:85066408702
ISSN
2045-7634
DOI
10.1002/cam4.2126
language
English
LU publication?
yes
id
cea12b58-f15a-4875-b7ae-ab84314a0082
date added to LUP
2019-07-01 14:44:18
date last changed
2020-10-20 02:53:58
@article{cea12b58-f15a-4875-b7ae-ab84314a0082,
  abstract     = {<p>Background: Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle-invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods: We selected patients with muscle-invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all-cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period. Results: The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5-1.6). In the “trial population,” all-cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow-up, 95% confidence interval −41 to 29. Conclusion(s): Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity-score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations.</p>},
  author       = {Häggström, Christel and Garmo, Hans and de Luna, Xavier and Van Hemelrijck, Mieke and Söderkvist, Karin and Aljabery, Firas and Ströck, Viveka and Hosseini, Abolfazl and Gårdmark, Truls and Malmström, Per Uno and Jahnson, Staffan and Liedberg, Fredrik and Holmberg, Lars},
  issn         = {2045-7634},
  language     = {eng},
  number       = {5},
  pages        = {2196--2204},
  publisher    = {Wiley-Blackwell},
  series       = {Cancer Medicine},
  title        = {Survival after radiotherapy versus radical cystectomy for primary muscle-invasive bladder cancer : A Swedish nationwide population-based cohort study},
  url          = {http://dx.doi.org/10.1002/cam4.2126},
  doi          = {10.1002/cam4.2126},
  volume       = {8},
  year         = {2019},
}