Real-world treatment patterns, recurrence, and overall survival of patients with muscle-invasive bladder cancer undergoing radical cystectomy in U.S. oncology practice

BACKGROUND: The most common treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), typically combined with neoadjuvant and/or adjuvant therapy. This study aimed to describe patient characteristics, treatment patterns, recurrence, and overall survival (OS) among a contemporary cohort of patients with MIBC who underwent RC. METHODS: This retrospective study included adult patients with MIBC (T2-T4aN0M0/T1-T4aN1M0) who underwent RC between January 1, 2008 and July 31, 2023 and were captured in the U.S. ConcertAI Patient360™ Bladder Cancer electronic medical record database. Index date was defined as the date of RC. Recurrence (first evidence of disease following RC) and OS were analyzed using Kaplan-Meier methods and stratified by disease stage and treatment received. The association of recurrence with OS was assessed using Cox regression. RESULTS: A total of 783 RC-treated MIBC patients were included (median age 68 years; male 78.8%; White 87.6%; de novo MIBC 77.1%; pure urothelial histology 76.6%), with a median follow-up of 26.2 months. Neoadjuvant therapy use increased from 30.3% in 2011-2013 to 67.9% in 2020-2022. Among patients who received neoadjuvant therapy, 26.3% achieved pathological complete response (pT0N0) at RC. The 5-year recurrence and OS rates were 45.2% and 48.2%, respectively, varying by stage and treatments received. Mortality was 4.4 times higher [95% CI: 3.5, 5.6] among patients with recurrence compared with those without. CONCLUSION: Despite increased utilization of perioperative therapy over the past 2 decades, MIBC patients undergoing RC continue to experience high rates of disease recurrence, which are associated with increased mortality.