Tumor Location May Predict Adverse Pathology and Survival Following Definitive Treatment for Bladder Cancer: A National Cohort Study

Background: While urothelial carcinoma of the bladder is often considered a multifocal disease, the location of the dominant tumor may be prognostic. Objective: To determine the association between intravesical tumor location and both adverse pathological outcomes as well as overall survival. Design, settings, and participants: Patients in the National Cancer Database (2010–2015) with nonmetastatic urothelial carcinoma of the bladder who underwent primary treatment with radical cystectomy (RC; n = 3464) or chemoradiotherapy (CRT; n = 699). Outcome measurements and statistical analysis: Multivariable logistic regressions assessed the prognostic ability of tumor location to predict adverse pathology at RC (nodal metastases [pN + ] or advanced stage [pT3–4]). Cox regressions were used to determine the effect of tumor location on overall survival in patients treated with RC or CRT. Results and limitations: Following RC, 822 (24%) patients were pN+ and 1551 (55%) were pT3–4. Trigonal tumors were most likely to have adverse pathology (31% pN+ and 59% pT3–4), while anterior wall tumors were the least (19% pN+ and 50% pT3–4). Relative to the anterior wall, trigone (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.12–2.43, p = 0.012) and bladder neck (OR 1.79, 95% CI 1.11–2.90, p = 0.018) tumors were associated with increased odds of pN+ and dome (OR 1.56, 95% CI 1.08–2.24, p = 0.017) with pT3–4. In those patients treated with primary CRT, trigone involvement was associated with worse survival (HR 1.58, 95% CI 1.17–2.13, p = 0.003). Limitations included unmeasured variables and a relatively few number of patients with certain tumor locations. Conclusions: Trigone and bladder neck tumors are associated with increased odds of nodal involvement, and dome with a higher tumor stage at RC. Patients with trigone involvement may have worse overall survival following CRT. Patient summary: Location of the tumor within the bladder may be associated with worse cancer staging at the time of the surgery and worse survival following chemoradiotherapy. In a national cohort of patients who underwent radical cystectomy for bladder cancer, trigone and bladder neck tumors were associated with increased odds of nodal involvement, while dome tumors were associated with a higher pathology stage. Trigone tumors were associated with worse overall survival following primary chemoradiotherapy.