Evidence map›Paper›PMID 34812723›Full record

ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2022

Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: A Markov microsimulation model.

Diana Magee, Douglas Cheung, Amanda Hird, Srikala S Sridhar, Charles Catton, Peter Chung, Alejandro Berlin, Padraig Warde, Alexandre Zlotta, Neil Fleshner and 1 more

Open access · diamondAbstract read
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Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Diana MageeDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Douglas CheungDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Amanda HirdDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Srikala S SridharDivision of Medical Oncology, Department of Internal Medicine, University of Toronto, Toronto, ON, Canada.
Charles CattonDepartment of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Peter ChungDepartment of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Alejandro BerlinDepartment of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Padraig WardeDepartment of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Alexandre ZlottaDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Neil FleshnerDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Girish S KulkarniDivision of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
University of Toronto · CAUniversity Health Network · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionRadical cystectomy (RC) is the historic gold standard treatment for muscle-invasive bladder cancer (MIBC), but trimodal therapy (TMT) has emerged as a valid therapeutic option for select patients. Given that prospective clinical trials have been difficult to perform in this area, our aim was to compare these two primary treatment strategies using decision analytic methods.

methodA two-dimensional Markov microsimulation model was constructed using TreeAge Pro to compare RC and TMT for patients with newly diagnosed MIBC. A comprehensive literature search was used to populate model probabilities and utilities. Our primary outcome was quality-adjusted life expectancy (QALE). Secondary outcomes included crude life expectancy (LE) and bladder cancer recurrences. The simulated patient for our model was an adult with MIBC (pT2-4 N0 M0) who was a candidate for either RC or TMT.

resultsA total of 500 000 patients were simulated. TMT resulted in an estimated mean QALE of 7.48 vs. 7.41 for RC. However, the average LE for patients treated with TMT was lower compared with RC (10.20 vs. 10.74 years). A sensitivity analysis evaluating the impact of age showed that younger patients treated with RC had greater QALE and longer LE than those treated with TMT; inverse findings were observed for elderly patients. Overall, 39.4% of patients treated with TMT experienced a bladder recurrence.

conclusionsRC results in a longer LE compared to TMT (0.54 years), but with a lower QALE (-0.07 years). The preferred treatment strategy varied with patient age.

Identifiers

PMID34812723
PMCPMC9054325
OpenAlexW3216069950

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.