Survival outcomes in metastatic bladder cancer patients in the United States.

675 Background: Bladder cancer is the 10 th leading cause of cancer-related death in the United States. Over the last 15 years, multiple agents have been approved for metastatic bladder cancer. The main objective of our study was to evaluate trends and predictors of survival outcomes among patients diagnosed with metastatic disease in the U.S. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program (~48% of the U.S. population). Adults diagnosed with metastatic bladder cancer (ICD-10: C67.0-C67.9) between 2010 and 2021 were included. Follow-up continued until death or December 2021. Kaplan-Meier methods estimated overall survival (OS) and cancer-specific survival (CSS), with median and 5-year survival rates reported. Cox proportional hazards models identified predictors of survival. Results: A total of 6,601 patients were included; 54% were diagnosed in 2017 or later. Mean age was 69 years; 65% were ≥65 years. Most were male (70%), had transitional cell carcinoma (82%), and underwent prior bladder surgery (78%). Liver or lung metastases were present in 46%. Median OS was 7 months, with a 5-year OS rate of 7%; median CSS was 8 months, with a 5-year CSS rate of 10%. In patients <65 years (n= 2,306), median OS and CSS were 9 months, with 5-year rates of 9% and 11%, respectively. In patients ≥65 years (n=4,295), median OS and CSS were 6 and 7 months, respectively, with 5-year survival rates of 7% and 10%. Five-year relative survival improved from 6% among patients diagnosed in 2010 (n=473) to 9% among patients diagnosed in 2015 (n=584) and 12% among patients diagnosed in 2021 (n=653). Age, race, gender, histology, and absence of prior surgery were significant predictors of OS and CSS (p < 0.05). Conclusions: Gains in long-term survival suggest incremental benefits from newer therapies. While clinically meaningful strides have been made in the treatment of metastatic bladder cancer over the past decade, there remains opportunity to further advance treatment. Continued development of novel agents, especially for subgroups with poor prognosis, is needed to achieve more meaningful improvements. Median and 5-year survival rates among patients with metastatic bladder cancer. Parameter Population Median (Q1, Q3)(months) 5-year survival (%) 5-year relative survival (%) 2010 2015 2021 OS Overall 7.0 (3.0, 16.0) 7.4 (6.6 – 8.2) 6 9 12 < 65 years 9.0 (4.0, 19.0) 8.9 (7.7 – 10.5) 7 9 13 ≥ 65 years 6.0 (2.0, 14.0) 6.5 (5.7 – 7.5) 6 8 12 CSS Overall 8.0 (3.0, 18.0) 10.2 (9.3 – 11.2) NA NA NA <65 years 9.0 (4.0, 21.0) 11.2 (9.7 – 13.0) NA NA NA ≥ 65 years 7.0 (3.0, 17.0) 9.6 (8.5 – 10.9) NA NA NA NA: Not applicable.