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International Journal of
Cancer and Clinical Research ISSN: 2378-3419

Citation

Robbrecht DG, Verhoeven RHA, de Vries P, van der Heijden MS, Boormans JL, et al. (2019) Impact of a Dedicated Multidisciplinary Research and Treatment Network on Outcomes of Muscle-Invasive Bladder Cancer Patients. Int J Cancer Clin Res 6:105. doi.org/10.23937/2378-3419/1410105

Copyright

© 2019 Robbrecht DG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which spermits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ORIGINAL ARTICLE | OPEN ACCESSDOI: 10.23937/2378-3419/1410105

Impact of a Dedicated Multidisciplinary Research and Treatment Network on Outcomes of Muscle-Invasive Bladder Cancer Patients

Debbie G Robbrecht1*, Rob HA Verhoeven2, Peter de Vries3, Michiel S van der Heijden4, Joost L Boormans5 and Ronald de Wit1 (on behalf of the Dutch Uro-oncology Study group (DUOS))

1Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands

2Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands

3Department of Urology, Zuyderland Hospital , Heerlen, The Netherlands

4Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands

5Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

Abstract

Background

The Dutch Uro-Oncology Study Group (DUOS) is a multidisciplinary network of ~30 hospitals involved in research and treatment of urological cancers. We analyzed the influence of treatment at DUOS versus non-DUOS on survival of muscle-invasive bladder cancer (MIBC) patients and explored correlating parameters.

Patients and methods

Characteristics of 3472 cT2-4aN0/XM0 MIBC patients who underwent radical cystectomy (RC), with or without neoadjuvant chemotherapy (NAC), were collected by the Netherlands Cancer Registry (NCR). 5-year overall survival (OS) was estimated by the Kaplan-Meier method. Cox regression analyses were performed to determine hazard ratios for pre-defined variables.

Results

5-year OS differed 3.2% in favor of DUOS centers (49.3% vs. 46.1%, p = 0.09). Best survival was observed in patients treated with NAC and RC at DUOS centers (5-year OS 57%). This was 61.1% in cT3-4 patients treated at DUOS centers. NAC was only significantly associated with improved survival in cT3-4a patients treated at DUOS centers (p = 0.0002). Positive surgical margins were less frequent (p = 0.02) and more pelvic lymph nodes (LNs) were collected and identified (p = 0.001) at DUOS centers. Surgical margins, number of identified LNs, and number of positive LNs significantly correlated with OS.

Conclusions

We identified a greater survival benefit by the use of NAC, a higher number of LNs identified, a lower rate of positive surgical margins and a trend towards survival benefit in patients treated at centers that collaborate in the multidisciplinary DUOS national network.

Implications for practice

Our retrospective analysis based on 3472 muscle-invasive bladder cancer patients, showed a non-significant trend towards survival benefit when treated in hospitals involved in a national study-group network (DUOS), with significantly superior outcomes concerning neo-adjuvant chemotherapy, surgical margins and lymph node dissection. These factors significantly correlated with an improved survival, favoring treatment at centers that are involved in a multidisciplinary national network with dedicated care for bladder cancer.