PC, RC May Offer Similar Survival in MIBC Patients

PARTIAL AND RADICAL cystectomy for muscle-invasive bladder cancer (MIBC) are associated with similar survival outcomes in selected patients, according to study findings presented at the AUA2021 Virtual Experience.

If confirmed, partial cystectomy (PC) may be a viable option to treat MIBC, according to investigators Rainjade Chung, MD, of Columbia University in New York, New York, and colleagues.

“While radical cystectomy is the gold standard for muscle-invasive bladder cancer, there is some data showing that partial cystectomy can be an effective alternative in select patients,” Dr Chung told attendees. “Patients are usually reluctant to have their bladder removed, and the interest in bladder-sparing options lies in the ability for nerve preservation for potency, to maintain continence, to preserve continuity of the urinary tract, and all the benefits of improved body image and decreased morbidity from surgery.”

Their study included 637 patients with MIBC identified using the National Cancer Database (2003-2015). Of these, 79 (12%) underwent partial cystectomy (PC). The PC patients were older than those in the radical cystectomy (RC) group. They were more likely to have positive surgical margins (19% vs 10%) but had a lower rate of positive lymph nodes on surgical pathology (5% vs 27%).

Investigators found no significant difference in the rate of upstaging to pT3-4 (67% in RC vs 71% in PC) or in overall survival.

“Based on our findings, partial cystectomy appears to afford similar survival outcomes to radical cystectomy in a large population-based data set,” Dr Chung said.

Mortality Risk Factors On multivariable analysis, patients undergoing either PC or RC using a minimally invasive approach had a significant 66% decreased risk for death compared with those having an open procedure, according to investigators.

The presence of positive surgical margins, compared with their absence, was significantly associated with a 2.7-fold increased risk for death. Compared with node-negative disease, nodepositive disease was significantly associated with a 3.1-fold increased risk.

Patient Selection Key “This study suggests that partial cystectomy in select patients may have comparable overall survival to radical cystectomy, but it is worth emphasizing the patient selection is key,” Matthew Wszolek, MD, a urologic oncologist at Massachusetts General Hospital and an assistant professor at Harvard Medical School in Boston, who was not involved in the study. “Further, the one longterm concern for partial cystectomy is future-life threatening recurrence of bladder cancer … that may occur 5, 10, 15 years in the future, and this risk is not accounted for in this study.” He noted that most urologic oncologists use PC in selected patients, and the current study supports the practice. ■