Retrospective analysis of 5-year overall survival after trimodal therapy and radical cystectomy in real clinical practice

Introduction

Radical cystectomy (RC) with pelvic lymph node dissection, with or without neoadjuvant chemotherapy, remains the standard treatment for non-metastatic muscle-invasive bladder cancer (MIBC). However, due to the high complication rates and low quality of life in the early and distant postoperative period, an alternative trimodal treatment option has been proposed, allowing bladder preservation. This approach involves maximal transurethral resection (TUR) of the bladder tumor combined with chemoradiotherapy. Clinical trial results have shown that trimodal therapy (TMT) can achieve longterm overall survival (OS) comparable to modern RC methods. The article presents a retrospective analysis of 5-year OS in patients with MIBC T2-3N0-3M0 after RC or TMT in real clinical practice. 

Objective

To compare the 5-year overall survival (OS) of patients with MIBC after TMT and RC.

Materials and Methods

Based on the results of a multicenter cohort retrospective study of 174 patients with MIBC T2-3N0-3M0, a comparative analysis of 5-year OS after TMT and RC was conducted.

Results

It was found that regardless of age, gender, T, and N, the 5-year OS was significantly higher in patients after TMT compared to RC: 46,0% versus 36.0%, p<0.0095. In early-stage disease in patients with non-metastatic MIBC (T2N0M0), the 5-year OS was significantly higher after TMT: 59,52% versus 51,92% in the RC group, p=0.0392.

Conclusion
In real clinical practice, the 5-year OS after TMT was comparable to RC and therefore may be a reasonable alternative for patients with localized non-metastatic MIBC (T2N0M0) who are not suitable for RC.