Short-term Mortality Associated with Definitive Chemoradiotherapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer

Muscle-invasive bladder cancer can be treated with either radical cystectomy or definitive chemoradiation. This study compares short-term mortality between patients treated with these 2 treatment modalities, and demonstrates worse short-term mortality in patients undergoing radical cystectomy, particularly in the older patient population. Background: Muscle-invasive bladder cancer (MIBC) may be managed with radical cystectomy (RC) or chemo-radiotherapy (CRT). Because patient selection for RC is important to avoid treatment-related mortality, this study addressed a knowledge gap by quantifying short-term mortality with both approaches, as well as predictors thereof. Materials and Methods: The National Cancer Database was queried (2004-2014) for clinically staged T2-4aN0M0 MIBC that received either CRT or RC. Statistics included cumulative incidence comparisons of 30- and 90-day mortality between patients treated with either CRT or RC and Cox regression to evaluate predictors thereof. Results: Of 16,658 patients, 15,208 (91.3%) underwent RC and 1450 (8.7%) CRT. Crude rates of post-treatment mortality at 30 days were 2.7% versus 0.6% (P <.001) and at 90 days were 7.5% versus 4.5% (P = .017) for patients treated with RC and CRT, respectively. When stratifying by age, worse 30- and 90-day mortality with RC was observed for patients aged >= 76 years. Conclusions: This study describes 30- and 90-day mortality following RC versus CRT. Both approaches yield statistically similar treatment-related mortality rates in patients <= 75 years of age; however, worse post-treatment mortality was observed with use of RC in patients >= 76 years of age. These results may be utilized to better inform shared decision-making between patients and providers when weighing both RC and CRT for MIBC. (C) 2019 Elsevier Inc. All rights reserved.