Characteristics, management and survival outcomes in patients with muscle-invasive bladder cancer at high risk of recurrence in France: a subgroup analysis from the coblance cohort

Abstract

Purpose

To describe characteristics, management, disease-free survival and overall survival of patients with muscle-invasive bladder cancer (MIBC) at high risk of recurrence (MIBC-HR) undergoing radical cystectomy in France and a subgroup of these patients who did not receive adjuvant chemotherapy after RC and were managed with active surveillance only (MIBC-HR-ASO).

Methods

Patients aged ≥ 18 years with MIBC who had radical cystectomy from October 2012 to June 2018 were identified in the prospective COBLAnCE bladder cancer cohort. Patients with metastatic disease were excluded. Patients were classified as MIBC-HR based on TNM staging. Disease-free and overall survival were estimated using the Kaplan-Meier method with their 95% confidence intervals (95%CI).

Results

256 patients with MIBC-HR were enrolled. The median age at diagnosis was 68.5 years and 204 patients were men (79.7%). 201 patients (78.5%) were current or former smokers. For staging, 226 patients were (y)pT3a or higher (88.3%) and 132 were N- (51.6%). Forty-six patients received neoadjuvant chemotherapy (18.0%), and 69 received adjuvant chemotherapy (27.0%). Of the patients receiving adjuvant chemotherapy only, 59 received cisplatin-based therapy (86.8%). 182 patients (71.1%) constituted the ASO subgroup. 175 patients (68.3%) experienced an event up to the end of follow-up. Median follow-up was 5.0 years. Median disease-free survival was 1.30 years [95%CI: 1.01–1.60] in the MIBC-HR cohort and 1.21 years [95%CI: 0.70–1.53] in the MIBC-HR-ASO subgroup. Median overall survival was 2.31 years [95%CI: 1.85–3.10] in the MIBC-HR cohort and 2.11 years [95%CI: 1.61–2.65] in the MIBC-HR-ASO subgroup. At 5 years, DFS was 27.4% [21.7;33.9%] in the MIBC-HR population and 23.7% [17.4;31.4] in the MIBC-HR-ASO population. OS at five years was 33.2% [27.1;40.0] for the MIBC-HR population and 29.6% [22.7;37.7] for the MIBC-HR-ASO population.

Conclusion

Using real-world data, this study underscores the challenging prognosis of patients with MIBC-HR managed with RC, regardless of whether they receive adjuvant chemotherapy. New treatment protocols, such as the use of immunotherapies, may improve OS in this type of cancer, especially in the current therapeutic landscape where no highly effective treatment exists.