Surgical removal of bladder cancer yields no improvements for survival, study finds

Bladder cancer is one of the 10 most common cancers in the world and the United States, with urothelial carcinoma (UC) being the most commonly diagnosed form. Also known as transitional cell carcinoma, UC originates in the cells lining the interior of the bladder. Approximately 5 percent of new cases of UC are metastatic (mUC) and can spread to other areas of the body.

Although mUC is usually treated with chemotherapy or immunotherapy, the overall five-year survival rates are poor. Overall survival rates for other forms of cancer can be improved by the surgical removal of tumors (metastasectomy), and some smaller studies have shown a possible association between surgical removal of mUC masses and improved overall survival.

In a study recently published in Urologic Oncology: Seminars and Original Investigations, a multi-institutional team including Taehyun Roh, PhD, assistant professor in the Department of Epidemiology and Biostatistics at the Texas A&M University School of Public Health, examined data from the National Cancer Database (NCDB) to analyze usage trends of metastasectomy of mUC and the relationship between undergoing the procedure and overall survival. The NCDB is a large national registry of data from more than 1,500 hospitals across the United States.

The researchers first gathered data on a total of 11,601 patients who had mUC and either did or did not undergo metastasectomy as part of their treatment from 2004 to 2016. In addition to overall survival, the research team analyzed the data for characteristics of patients who underwent the procedure and the usage rate of the procedure over time.

The analysis found no association between improved overall survival and undergoing metastasectomy. The average rate of metastasectomy was 6.8 percent from 2004 to 2016, with no significant changes from year to year. Patients undergoing the procedure usually were younger, had private insurance, underwent the procedure in an academic medical center, and received systemic therapy.

The findings from the study suggest that although surgical removal of metastatic tumors may be beneficial for survival for other forms of cancer, no such benefit appears to exist for bladder cancer. The researchers note that the role of metastasectomy in treatment plans may need to be re-evaluated, especially for patients with certain characteristics.

– by Kelly Tucker