Radical cystectomy vs. multimodality treatment in T2N0M0 bladder cancer: a population-based, age-matched analysis

Abstract Background : Controversy still exists regarding efficacy of multimodality treatment (MMT) vs. radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCUB). Methods : Within the SEER-database (2004–2016), we retrospectively identified stage T2N0M0 UCUB patients. Competing-risks-regression (CRR) tested cancer-specific-mortality (CSM) and adjusted for other cause mortality after MMT vs. RC. Exact matching for age was applied. Subgroup analyses focused on differences in chemotherapy or lymph node dissection rates. In sensitivity analyses, we accounted for 40% understaging rate in MMT patients. Results : Of 9862 T2N0M0 UCUB patients, 2675 (27.1%) underwent MMT vs. 5751 (58.3%) RC vs. 1436 (14.6%) RT without chemotherapy. MMT rate increased (annually +3.0%, p Conclusion : In T2N0M0-patients, MMT or even more so RT alone, may be associated with higher CSM than RC, even in exact age-matched multivariate CRR analyses, that adjust for other cause mortality. In consequence, T2 UCUB patients should be informed of this possible CSM disadvantage outside of highly specialized centers.