Non-metastatic muscle-invasive bladder cancer: the role of age in receiving treatment with curative intent
van Hoogstraten, Lisa M C; Witjes, J Alfred; Meijer, Richard P; Ripping, Theodora M; Kiemeney, Lambertus A; Aben, Katja K H; BlaZIB Study Group
(2022) BJU International, volume 130, issue 6, pp. 764 - 775
(Article)
Abstract
OBJECTIVES: To evaluate which patient and tumour characteristics are associated with remaining untreated in patients with potentially curable, non-metastatic muscle-invasive bladder cancer (MIBC), and to compare survival of untreated vs treated patients with similar characteristics. PATIENTS AND METHODS: For this cohort study, 15 047 patients diagnosed with cT2-T4aN0/xM0/x urothelial MIBC between
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2005 and 2019 were identified in the Netherlands Cancer Registry. Factors associated with remaining untreated were identified using logistic regression analyses. Interhospital variation was assessed using multilevel analysis. Using a propensity score, the median overall survival (mOS) of untreated and treated patients was evaluated. Analyses were stratified by age (<75 vs ≥75 years). RESULTS: One-third of patients aged ≥75 years remained untreated; increasing age, worse performance status, worse renal function, cT4a stage and previous radiotherapy in the abdomen/pelvic area increased the odds of remaining untreated. One in 10 patients aged <75 years remained untreated; significant associations were only found for performance status, renal function and cT4a stage. Interhospital variation for remaining untreated was largest for patients aged ≥75 years, ranging from 37% to 69% (case-mix-adjusted). Irrespective of age, mOS was significantly worse for untreated patients: 6.4 months (95% confidence interval [CI] 5.1-7.3) vs 16.0 months (95% CI 13.5-19.1) for treated patients. CONCLUSION: On average, one in five patients with non-metastatic MIBC remained untreated. Untreated patients were generally older and had a more unfavourable prognostic profile. Untreated patients had significantly worse overall survival, regardless of age. Age alone should therefore not affect treatment decision-making. Considering the large interhospital variation, a proportion of untreated patients might be wrongfully denied life-prolonging treatment.
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Keywords: #BladderCancer, #blcsm, muscle-invasive bladder cancer (MIBC), patient and tumour characteristics, survival, treatment, urothelial bladder carcinoma, variation in healthcare, Urology, Journal Article
ISSN: 1464-4096
Publisher: Wiley-Blackwell
Note: Funding Information: The BlaZIB study is supported by the Dutch Cancer Society (KWF; IKNL 2015–7914).The funding agency had no further role in this study. Funding Information: The BlaZIB study is supported by the Dutch Cancer Society (KWF; IKNL 2015–7914).The funding agency had no further role in this study. The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the NCR. The members of the BlaZIB study group (in addition to the authors) are as follows: Joost Boormans, MD, PhD (Erasmus Medical Centre), Theo M. de Reijke, MD, PhD (Amsterdam University Medical Centres), Catharina A. Goossens-Laan, MD, PhD (Alrijne hospital), Sipke Helder (Patient association ‘Leven met blaas- of nierkanker’), Maarten C.C.M. Hulshof, MD, PhD (Amsterdam University Medical Centres), Geert J.L.H. van Leenders, MD, PhD (Erasmus Medical Centre), Anna M. Leliveld, MD, PhD (University Medical Centre Groningen), Sasja F. Mulder, MD, PhD (Radboud University Medical Centre), Juus L. Noteboom, MD, PhD (University Medical Centre Utrecht), Jorg R. Oddens, MD, PhD (Amsterdam University Medical Centres), Tineke J. Smilde, MD, PhD (Jeroen Bosch ziekenhuis), Guus W.J. Venderbosch (Patient association ‘Leven met blaas- of nierkanker’), Antoine G. van der Heijden, MD, PhD (Radboud University Medical Centre), Michiel S. van der Heijden, MD, PhD (Netherlands Cancer Institute), Reindert J.A. van Moorselaar, MD, PhD, Prof (Amsterdam University Medical Centres), Bas W.G. van Rhijn, MD, PhD, FEBU (Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital), Joep G.H. van Roermund, MD, PhD (Maastricht University Medical Centre), Bart P. Wijsman, MD, PhD (Elisabeth-TweeSteden Ziekenhuis). Publisher Copyright: © 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
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