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Prognostic factors and oncological outcomes after trimodality bladder-preserving therapy for muscle-invasive bladder
N Feltes Benítez1, F Couñago2, S Paredes-Rubio1
1Servicio de Oncología Radioterápica, Hospital Universitario de Terrassa (CST), Terrassa, Spain.
Introduction:
Trimodality therapy (TMT), consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy, is an established bladder-preserving option for selected patients with muscle-invasive bladder cancer (MIBC). However, contemporary multicenter real-world data are needed to better define oncological outcomes and prognostic factors in routine clinical practice.
Methods:
We conducted a retrospective multicenter cohort study including 369 patients with cT2-T4aN0M0 MIBC treated with definitive TMT between 2010 and 2022. Time-to-event outcomes were measured from radiotherapy completion and estimated using the Kaplan-Meier method. Endpoints included overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and progression-free survival (PFS). Bladder-preservation outcomes included complete local response (CLR) at first assessment and salvage cystectomy. Prognostic factors were evaluated using multivariable Cox proportional hazards regression.
Results:
Median age was 76 years (IQR 66.5-81.0), and 85.1% of patients were male. After a median follow-up of 27.4 months, OS at 1, 2, and 3 years was 85.8%, 75.7%, and 65.7%, respectively, while CSS was 90.5%, 84.7%, and 79.9%. MFS rates at 1, 2, and 3 years were 85.8%, 83.1%, and 80.6%, and corresponding PFS rates were 82.9%, 75.4%, and 71.6%. A complete local response was achieved in 63.7% of patients, and salvage cystectomy was required in 9.7%. On multivariable analysis, increasing age, poorer ECOG performance status, and lymphovascular invasion were independently associated with worse outcomes, whereas the use of modern radiotherapy techniques (IMRT/VMAT) was associated with improved survival compared with three-dimensional conformal radiotherapy.
Conclusions:
In this large contemporary real-world cohort, trimodality therapy achieved effective cancer control with durable bladder preservation and a low salvage cystectomy rate. While overall survival was influenced by baseline patient fitness, cancer-specific and metastasis-free outcomes remained favourable. These findings support TMT as a robust bladder-preserving strategy in routine clinical practice, provided that appropriate patient selection and high-quality radiotherapy delivery are ensured.
