Neoadjuvant Chemotherapy With Transurethral Resection for Bladder Preservation: 15-Year Follow-Up of the Retained...

Area of Science:

• Urology
• Oncology
• Cancer Research

Background:

• Bladder preservation is a key goal for muscle invasive bladder cancer (MIBC) patients.
• Established criteria identify ideal candidates, but robust long-term data on risks and benefits are limited.
• Heterogeneous patient cohorts and short follow-up periods complicate the assessment of bladder preservation strategies.

Purpose of the Study:

• To evaluate long-term outcomes for patients with MIBC who meet ideal criteria for bladder preservation.
• To assess the efficacy of initial treatment with systemic therapy followed by transurethral resection (TUR).
• To determine bladder-intact survival, local recurrence-free survival, and cancer-specific survival in this select group.

Main Methods:

• Retrospective review of 101 prospectively monitored patients meeting "ideal" bladder preservation criteria.
• Patients received neoadjuvant chemotherapy (Cisplatin-based) and TUR.
• Follow-up exceeded 10 years, with primary endpoints including bladder-intact survival, local recurrence, and cancer-specific survival.

Main Results:

• The 15-year risk of death from bladder cancer was 11%, with a 44% competing risk of death from other causes.
• Approximately 40% of patients achieved long-term bladder preservation, while 11% required cystectomy.
• Local recurrence occurred in one-third of patients with intact bladders, indicating a need for lifelong surveillance.

Conclusions:

• Bladder preservation using neoadjuvant chemotherapy and TUR is a viable strategy for carefully selected MIBC patients.
• The decision for bladder-sparing treatment requires careful consideration of long-term preservation probabilities against the risk of excess mortality.
• These findings highlight the importance of established selection criteria and the necessity of ongoing monitoring for recurrence.