Survival after trimodal therapy in octogenarians with organ-confined urothelial bladder cancer

Objectives: It is not known whether cancer-specific mortality (CSM) differences distinguish radical cystectomy (RC) from trimodal therapy (TMT) in octogenarians harbouring organ-confined (T2N0M0) urothelial cancer of the urinary bladder (UCUB).

Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2021), CSM and other-cause mortality (OCM) rates were computed in octogenarian patients with organ-confined UCUB undergoing either TMT or RC. Smoothed cumulative incidence plots depicted 5-year CSM and OCM rates according to RC vs TMT. Competing risks regression (CRR) models were fitted, adjusting for age, gender, and race/ethnicity. Nearest-neighbour 1:1 propensity-score matching (PSM) for age and gender was also applied. Sensitivity analyses were additionally performed, focusing on White patients.

Results: Of 2335 octogenarian patients with T2N0M0 UCUB, 1562 (66.3%) received TMT and 793 (33.7%) received RC. Of those, 2082 (88.4%) were White. TMT rates increased from 53.5% in 2004 to 82.2% in 2021 (P < 0.001). The 5-year CSM rate was 50.1% for TMT vs 31.1% for RC. After multivariable CRR, TMT independently predicted 1.7-fold higher CSM (P < 0.001). After additional PSM, TMT also independently predicted 1.7-fold higher CSM (P < 0.001). In sensitivity analyses exclusively focusing on White patients, almost identical results were recorded.

Conclusion: Rates of TMT have nearly doubled in octogenarian patients with organ-confined UCUB in recent years; however, CSM rates after TMT are also nearly twice as high as those observed after RC. It is crucial to communicate these observations.