3345 - Long-Term Outcomes after Trimodality Therapy for Muscle-Invasive Bladder Cancer: A Single Institution Experience
Presenter(s)
P. A. Papanikolaou1, S. Kacker1, A. S. Weitzner2,3, A. Grutman2, S. Mehta2, T. S. Garman3, Y. Jing3, A. N. Halthore1, A. P. Kiess1, S. C. Greco1, A. Smith3, S. H. Patel3, N. Singla3, B. A. Johnson4,5, J. Hoffman-Censits4,5, C. Deville Jr1, D. Song1, N. M. Hahn4,5, M. R. Kates3,5, and M. Goldstein1; 1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 4Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 5Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
Purpose/Objective(s): Trimodality therapy (TMT), consisting of transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation (CRT), is a bladder-sparing treatment approach for muscle-invasive bladder cancer (MIBC). This study reports on our institutional experience with TMT.
Materials/Methods: We performed a retrospective review of patients with cT2–T4aN0M0 urothelial carcinoma of the bladder treated with TMT between 2007 and 2023 at a high-volume academic center. All patients underwent TURBT followed by CRT; neoadjuvant chemotherapy (NAC) and concurrent/adjuvant immunotherapy (IO) were permitted. Endpoints included overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Survival was estimated using the Kaplan-Meier method; univariate and multivariate Cox proportional hazards models were used to assess associations between clinical covariates and OS, DSS, and DFS.
Results: One hundred sixteen patients were identified. Median follow-up was 8.1 years (reverse Kaplan-Meier method). Median age was 76 (range 49–96); 78% were male and 84% had a performance status (PS) score of Eastern Cooperative Oncology Group (ECOG) 0–1 or Karnofsky PS (KPS) =80. Most tumors were cT2 (71%), with 25% cT3 and 4% cT4a. Ten percent of patients received NAC and 61% had a complete TURBT prior to CRT; 8% received concurrent/adjuvant IO. Eighty percent had a complete response to CRT by cystoscopic assessment. Median OS, DSS, and DFS were 4.9, 12.7, and 2.7 years, respectively. Two-, 5-, and 10-year survival rates were 75%, 49%, and 25% for OS; 87%, 68%, and 68% for DSS; and 59%, 32%, and 9% for DFS. On univariate analysis, increasing age (HR 1.05, 95% CI 1.02–1.07), lower PS (ECOG 2–3, KPS =70) (HR 3.30, 95% CI 1.66–6.53), and multifocal disease (MFD) (HR 1.72, 95% CI 1.05–2.80) were associated with worse OS. Age and PS remained significant in multivariate analysis (aHR 1.04 and aHR 3.45, p < 0.01). Lower PS correlated with worse DSS (HR 3.06, 95% CI 1.04–8.95) and DFS (HR 3.95, 95% CI 1.96–7.96). The same relationship was observed for MFD (DSS HR 3.22, 95% CI 1.59–6.52; DFS HR 2.01, 95% CI 1.25–3.23) and carcinoma in situ (CIS) (DSS HR 2.53, 95% CI 1.24–5.13; DFS HR 1.82, 95% CI 1.15–2.90). Overall, 43% developed recurrence (17% locoregional, 12% distant, 14% both locoregional and distant); 36% of locoregional recurrences were isolated noninvasive recurrences. Ten patients (9%) underwent salvage cystectomy.
Conclusion: The patients in this series achieved favorable long-term survival outcomes and high rates of bladder preservation. Unlike protocol-based studies with highly selected patients, our study reflects a real-world patient population, providing insights into TMT outcomes in routine practice. PS was the strongest independent predictor across survival endpoints; older age, multifocal disease, and CIS were additional adverse factors. These results support TMT as an effective bladder-sparing option.