Comparative Analysis of Oncological Outcomes between Trimodal Therapy and Radical Cystectomy in Patients with Variant...

The aim of this study was to assess whether trimodal therapy (TMT) and radical cystectomy (RC) differ in terms of progression and survival outcomes in bladder cancer patients with variant histology (VH). A total of 57 patients diagnosed with VH, treated by either RC or TMT at our clinic between January 2013 and June 2024, were evaluated in this study. Group 1 (n = 44) included patients treated with TMT, while Group 2 (n = 13) consisted of those who underwent RC. The mean age of the patients was 64.43 ± 11.1 years. No statistically significant differences were observed between Group 1 and Group 2 in terms of PFS (p = 0.24), CSS (p = 0.07), or OS (p = 0.85). Patients with clinical stage < T2 demonstrated significantly improved PFS, OS, and CSS outcomes compared to those with stage ≥ T2 (p = 0.006, p = 0.006, and p = 0.001, respectively). Multivariable analysis identified T stage as an independent risk factor for PFS, CSS, and OS, irrespective of age, treatment modality, and VH type (HR: 5.45, p = 0.01; HR: 3.67, p = 0.006; and HR: 2.68, p = 0.01, respectively). While tumor stage remains a key prognostic factor in VH, our findings suggest that TMT may be a viable alternative to RC.