Bladder sparing surgery in high-grade bladder cancer.

Area of Science:

• Uro-oncology
• Surgical oncology
• Bladder cancer management

Background:

• Radical cystectomy (RCE) is the standard treatment for muscle-invasive bladder cancer (MIBC).
• RCE is associated with significant perioperative morbidity and mortality.
• High-grade bladder cancer (HGBC) has distinct biomolecular markers differentiating it from non-invasive disease.

Purpose of the Study:

• To evaluate cancer-specific survival in HGBC patients based on surgical treatment modality: RCE, partial cystectomy, or transurethral resection of the bladder (BPS).
• To assess the prevalence of bladder-sparing surgical management for HGBC within a trimodal treatment approach.
• To test the hypothesis that BPS does not compromise oncological outcomes in selected HGBC patients.

Main Methods:

• Retrospective analysis of 3597 urothelial bladder cancer patients (2004-2017), with a focus on 346 with HGBC.
• Surgical treatment choice (RCE, partial cystectomy, transurethral resection) based on tumor size, location, and feasibility.
• Kaplan-Meier survival analysis, controlled for adjuvant radiotherapy and chemotherapy.

Main Results:

• Median follow-up was 93 months; 61% of patients died from disease progression.
• For muscle-invasive disease (309 patients), RCE was performed in 35.3%, partial cystectomy in 25.6%, and transurethral resection in 39.1%.
• Five-year survival rates for Stage I, II, III, and IV HGBC patients were 0%/83%, 43%/58%, 37%/42%, and 10%/40% for RCE/BPS, respectively.

Conclusions:

• Bladder-sparing surgery (partial cystectomy, transurethral resection) is oncologically equivalent to RCE for selected HGBC patients across all stages.
• Bladder-sparing surgery was utilized in 64.7% of HGBC patients.
• Adjuvant treatment utilization was low: 12.7% for postoperative radiotherapy and 4% for perioperative chemotherapy.