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11 november 2019:
Tussen een open operatie en een operatie met een robot van blaaskanker zit geen noemenswaardig verschil in overall overleving of kans op een recidief of de omvang en ernst van complicaties blijkt uit een postpectieve studie:
10-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy
Van alle patienten (N = 446) die werden gevolgd had 10% van de patienten aanvullend chemotherapie gehad, (NAC), 51% had een complicatei gehad en 4% is overleden binnen 90 dagen.
Na 10 jaar was de recidiefvrije overleving 59%, de ziektespecifieke overleving 65% en de totale overleving 35%. Volgens de auteurs van de studie blijkt uit deze gegevens dat robotcystectomie, zelfs tijdens de vroege ontwikkeling ervan 10 jaar geleden, vergelijkbare resultaten biedt als open chirurgie.
15 juli 2018: Bron: JAMA
Oudere mensen (ouder dan 65 jaar) met gevorderde spier-invasieve blaaskanker zijn meer gebaat bij een radicale verwijdering van de blaas (cystectomy) dan een zogeheten trimodal procedure waarbij gedeeltelijk de blaas wordt weggehaald via TURP (transurethrale resectie van de blaas ) gevolgd door bestraling en chemo. De overall overleving en kanker specifieke overleving was beduidend minder voor de patienten uit de trimodalgroep dan die uit de groep van de radicale blaasresectie.
Ook de kosten waren beduidend hoger voor de trimodal behandeling dan voor de volledige blaasresectie. (na 180 dagen waren de kosten al $179 891 vs $107 017; mediaan verschil van $63 771.
Patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio , 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83).
Het volledige studierapport: RADICAL CYSTECTOMY PROVIDES IMPROVED SURVIVAL OUTCOMES AND DECREASED COSTS COMPARED WITH TRIMODAL THERAPY FOR PATIENTS DIAGNOSED WITH LOCALIZED MUSCLE-INVASIVE BLADDER CANCER dat m.i. nogal beperkte informatie verstrekt, is gratis in te zien.
Maar uit de 3200 deelnemers (periode 1 januari 2002, t/m 31 december 2011) werden er respectievelijk 687 patiënten (21.5%) geselecteerd voor de Trimodal procedure en eveneens 687 patiënten (21.5%) voor de radicale cystectomy. De patienten werden 10 jaar lang gevolgd. De analyse werd gemaakt tussen 1 augustus 2017 tot 11 maart 11 2018. Als je ziet wat dit allemaal heeft gekost en dat zoveel patienten een slechtere behandeling kregen dan vraag ik me toch weer opnieuw af waarom dit allemaal zomaar mag doorgaan. Ze maken mij niet wijs dat niet eerder al is gezien dat de trimodal procedure gewoon slechtere resultaten gaf. Maar ja.......
Hier het abstract van de studie:
Compared with radical cystectomy, trimodal therapy was associated with much lower overall and cancer-specific survival rates at markedly higher costs.
Source: JAMA Surg. Published online June 27, 2018. doi:10.1001/jamasurg.2018.1680
June 27, 2018
Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer
JAMA Surg. Published online June 27, 2018. doi:10.1001/jamasurg.2018.1680
Question What are the survival outcomes and costs associated with both radical cystectomy and trimodal therapy for older adults with muscle-invasive bladder cancer?
Findings In this population-based cohort study of Surveillance, Epidemiology, and End Results–Medicare data from 3200 older adults with a clinical stage T2 to T4a bladder cancer diagnosis, patients who underwent trimodal therapy had significantly decreased overall and cancer-specific survival. The median total costs were substantially higher for trimodal therapy than for radical cystectomy ($827 million vs $492 million) for patients diagnosed in 2011.
Meaning Compared with radical cystectomy, trimodal therapy was associated with significantly lower overall and cancer-specific survival rates at significantly higher costs.
Importance Radical cystectomy is the guidelines-recommended treatment of muscle-invasive bladder cancer, but a resurgence of trimodal therapy has occurred. Limited comparative data are available on outcomes and costs attributable to these 2 treatments.
Objective To compare the survival outcomes and costs between trimodal therapy and radical cystectomy in older adults with muscle-invasive bladder cancer.
Design, Setting, and Participants This population-based cohort study used data from the Surveillance, Epidemiology, and End Results–Medicare linked database. A total of 3200 older adults (aged ≥66 years) with clinical stage T2 to T4a bladder cancer diagnosed from January 1, 2002, to December 31, 2011, and with claims data available through December 31, 2013, were included in the analysis. Patients who received radical cystectomy underwent either only surgery or surgery in combination with radiotherapy or chemotherapy. Patients who received trimodal therapy underwent transurethral resection of the bladder followed by radiotherapy and chemotherapy. Propensity score matching by sociodemographic and clinical characteristics was used. Data analysis was performed from August 1, 2017, to March 11, 2018.
Main Outcomes and Measures Overall survival and cancer-specific survival were evaluated using the Cox proportional hazards regression model and the Fine and Gray competing risk model. All Medicare health care costs for inpatient, outpatient, and physician services within 30, 90, and 180 days of treatment were compared. The total amount spent nationwide was estimated, using 180-day medical costs between treatments, by the total number of new cases of muscle-invasive bladder cancer in the United States in 2011.
Results Of the 3200 patients who met the inclusion criteria, 2048 (64.0%) were men and 1152 (36.0%) were women, with a mean (SD) age of 75.8 (6.0) years. After propensity score matching, 687 patients (21.5%) underwent trimodal therapy and 687 patients (21.5%) underwent radical cystectomy. Patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio , 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83). No differences in costs at 30 days were observed between trimodal therapy ($15 233 in 2002 vs $18 743 in 2011) and radical cystectomy ($17 990 in 2002 vs $21 738 in 2011). However, median total costs were significantly higher with trimodal therapy than with radical cystectomy at 90 days ($80 174 vs $69 181; median difference, $8964; Hodges-Lehmann 95% CI, $3848-$14 079) and at 180 days ($179 891 vs $107 017; median difference, $63 771; Hodges-Lehmann 95% CI, $55 512-$72 029). Extrapolating these figures to the total US population revealed $335 million in excess spending for trimodal therapy compared with the less costly radical cystectomy ($492 million) for patients who received a muscle-invasive bladder cancer diagnosis in 2011.
Conclusions and Relevance Trimodal therapy was associated with significantly decreased overall survival and cancer-specific survival as well as $335 million in excess spending in 2011. These findings have important health policy implications regarding the appropriate use of high value–based care among older adults with invasive bladder cancer who are candidates for either radical cystectomy or trimodal therapy.
Trimodal, post operatief bestraling en chemo, spier invasieve blaaskanker, cystectomy, TURP, operatie, kwaliteit van leven, overall overleving
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