Real-World Cancer Recurrence and Overall Survival Outcomes in Muscle-Invasive Bladder Cancer (MIBC) Patients Treated With Radical Cystectomy (RC): A Retrospective Surveillance, Epidemiology, and End Results-Medicare Study
Author(s)
Patrick Squires, PharmD, PhD1, Erin E. Cook, ScD2, Yan Song, PhD2, Ching-Yu Wang, PhD1, Anya Jiang, MPH2, Adina Zhang, MS2, Shravanthi M. Seshasayee, MPH2, Aljosja Rogiers, MD, PhD1, Haojie Li, MD, PhD1, Ronac Mamtani, MD, MSCE3;
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Hospital of the University of Pennsylvania-Penn Presbyterian Medical Center, Philadelphia, PA, USA
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Hospital of the University of Pennsylvania-Penn Presbyterian Medical Center, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: Real-world quantification of cancer recurrence and overall survival (OS) in radically resected MIBC patients is lacking, particularly outcomes by disease stage or treatment received. This study describes the overall clinical burden of MIBC patients undergoing RC and further examines the association between cancer recurrence and OS.
METHODS: The SEER-Medicare database (2007-2020) was used to identify patients with T2-T4aN0M0 or T1-T4aN1M0 MIBC. Index date was defined as date of RC. Kaplan-Meier approach was used to describe both recurrence rates and OS. Recurrence and OS were summarized among all patients and stratified by disease stage (T2N0, T3-T4aN0, or T1-T4aN1) and by treatment group (RC alone, RC plus NAC only, AC only, or NAC+AC). OS among patients with and without recurrence was compared using a Cox proportional hazards model, adjusted for disease, patient, and treatment factors.
RESULTS: Of 1,149 eligible RC-treated MIBC patients (60.2% T2N0; 31.7% T3-T4aN0; 8.1% T1-T4aN1), 53.6% received RC alone; the rest received RC plus NAC only (33.9%), AC only (10.2%), or NAC+AC (2.3%). The overall 5-year recurrence rate was 53.1% which varied across stages (T2N0: 46.0%; T3/4aN0: 61.1%; T1-T4aN1: 77.7%) and treatment groups (RC alone: 51.4%; RC plus NAC only: 47.6%, AC only: 69.3%, or NAC+AC: NE). The overall 5-year OS rate was 53.0% which varied across stages (T2N0: 61.3%; T3/4aN0: 42.6%; T1-T4aN1: 33.6%) and treatment groups (RC alone: 48.2%; NAC only: 66.9%, AC only: 42.0%, or NAC+AC: 38.0%). Patients with recurrence had significantly lower 5-year OS than patients without recurrence (29.3% vs 56.6%; HR = 1.88, 95% CI 1.54-2.28, p<0.001).
CONCLUSIONS: MIBC patients post-RC had high recurrence rates and poor overall survival, regardless of disease stage at diagnosis and treatment received. These findings underscore the substantial clinical burden for these patients and the need for effective therapies that may prevent recurrence and improve survival.
METHODS: The SEER-Medicare database (2007-2020) was used to identify patients with T2-T4aN0M0 or T1-T4aN1M0 MIBC. Index date was defined as date of RC. Kaplan-Meier approach was used to describe both recurrence rates and OS. Recurrence and OS were summarized among all patients and stratified by disease stage (T2N0, T3-T4aN0, or T1-T4aN1) and by treatment group (RC alone, RC plus NAC only, AC only, or NAC+AC). OS among patients with and without recurrence was compared using a Cox proportional hazards model, adjusted for disease, patient, and treatment factors.
RESULTS: Of 1,149 eligible RC-treated MIBC patients (60.2% T2N0; 31.7% T3-T4aN0; 8.1% T1-T4aN1), 53.6% received RC alone; the rest received RC plus NAC only (33.9%), AC only (10.2%), or NAC+AC (2.3%). The overall 5-year recurrence rate was 53.1% which varied across stages (T2N0: 46.0%; T3/4aN0: 61.1%; T1-T4aN1: 77.7%) and treatment groups (RC alone: 51.4%; RC plus NAC only: 47.6%, AC only: 69.3%, or NAC+AC: NE). The overall 5-year OS rate was 53.0% which varied across stages (T2N0: 61.3%; T3/4aN0: 42.6%; T1-T4aN1: 33.6%) and treatment groups (RC alone: 48.2%; NAC only: 66.9%, AC only: 42.0%, or NAC+AC: 38.0%). Patients with recurrence had significantly lower 5-year OS than patients without recurrence (29.3% vs 56.6%; HR = 1.88, 95% CI 1.54-2.28, p<0.001).
CONCLUSIONS: MIBC patients post-RC had high recurrence rates and poor overall survival, regardless of disease stage at diagnosis and treatment received. These findings underscore the substantial clinical burden for these patients and the need for effective therapies that may prevent recurrence and improve survival.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO34
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders