To evaluate the oncological outcomes of selective bladder preservation therapy, comprising maximal TURBT plus neoadjuvant chemotherapy (NAC) followed by 2nd-TURBT.
From 2012 to 2022, 110 localized muscle-invasive bladder cancer patients who desired bladder preservation (BP) received maximal TURBT plus NAC followed by restaging (CT scan+ 1st-TURBT) and 2nd-TURBT. Sixty-one patients with pure urothelial carcinoma of the urinary bladder (PUCUB) who achieved noninvasive downstaging (NID) after NAC and had no residual tumor at 2nd-TURBT underwent conservative treatment (BP group). Overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and cystectomy and distant metastasis-free survival (CDMFS) were estimated using the Kaplan-Meyer method. Propensity score matching was performed to compare the survival outcomes of patients in the BP group with those who underwent NAC + radical cystectomy (RC) and were diagnosed with ypT1 or less (RC group, n = 42). Multivariable Cox regression (MCR) models addressed survivals according to each treatment method.
In the BP group, 5-year OS, CSS, DMFS, and CDMFS were 87.4%, 93.8%, 83.1%, and 76.8%, respectively. MCR models for survival showed no differences in OS (BP: hazard ratio [HR] 1.24, P = .83), CSS (BP: HR 1.15, P = .74), and DMFS (BP: HR 1.09, P = .91) between the matched cohort.
BP therapy incorporating maximal TURBT plus NAC followed by 2nd-TURBT may be used as an alternative therapy to RC for selected muscle-invasive PUCUB patients. As this was a retrospective study, further randomized trials with longer follow-up are needed.
Clinical genitourinary cancer. 2024 Dec 10 [Epub ahead of print]
Takehisa Onishi, Takuji Shibahara, Sho Sekito, Manabu Kato, Yusuke Sugino, Takahiro Inoue
Department of Urology, Ise Red Cross Hospital, Ise, Japan. Electronic address: ., Department of Urology, Ise Red Cross Hospital, Ise, Japan., Department of Urology, Aichi Cancer Center, Nagoya, Japan., Department of Urology, Mie University hospital, Tsu, Japan.