Radical Cystectomy Offers Better Survival vs Trimodal Therapy


Radical cystectomy (RC) may be more effective and less costly than trimodal therapy for older adults with muscle-invasive bladder cancer (MIBC)

Authors analyzed outcomes in a cohort of 1374 patients with clinical stage T2 to T4a bladder cancer: 687 patients who underwent RC (alone or with chemotherapy or radiation) and a propensity score-matched group of 687 patients who received trimodal therapy. Patients were aged 66 years or older.

Patients who had trimodal therapy had a significant 49% increased risk of death from any cause and 55% increased risk of cancer-specific mortality compared with those who underwent RC. Cisplatin or 5-fluorouracil plus mitomycin C chemotherapies were associated with better survival than other regimens, but were still less effective than RC.

Trimodal therapy was significantly more expensive than RC over the short term. Median total costs to Medicare at 90 and 180 days were $8964 and $63,771 higher, respectively. 


Williams SB, Shan Y, Jazzar U, et al. Comparing survival outcomes and costs associated with radical cystectomy and trimodal therapy for older adults with muscle-invasive bladder cancer. JAMA Surg. doi:10.1001/jamasurg.2018.1680 [Published online June 27, 2018]

Cahn DB, Handord EA, Smaldone MC. Bladder extirpation vs preservation:The treatment debate. JAMA Surg. doi:10.1001/jamasurg.2018.1674 [Published online June 27, 2018]

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