Treatment Patterns and Outcomes in Localized Urothelial Carcinoma in Middle-Income Countries: A Multicenter
André Paternò Castello Dias Carneiro1,2, Elice Carneiro Batista1, Diogo Diniz Gomes Bugano1
1Hospital Israelita Albert Einstein, São Paulo, Brazil.
JCO Global Oncology
|April 29, 2026
Summary
Limited access to Bacillus Calmette-Guérin (BCG) and chemotherapy in middle-income countries hinders bladder cancer treatment. Real-world data reveal significant survival benefits when these therapies are available, highlighting urgent needs for improved healthcare access.
Area of Science:
- Urothelial Carcinoma Research
- Oncology
- Health Services Research
Background:
- Disparities in healthcare access and resources in middle-income countries contribute to suboptimal management of localized bladder urothelial carcinoma (UC).
- Limited real-world data exist on treatment patterns and outcomes for bladder cancer in these settings.
Purpose of the Study:
- To describe real-world treatment patterns and outcomes for localized bladder urothelial carcinoma (UC) in a middle-income setting.
- To identify barriers to guideline-concordant care for bladder cancer in resource-limited environments.
Main Methods:
- A multicenter, retrospective, real-world study of patients with high-risk non-muscle-invasive (HR-NMIBC) and muscle-invasive bladder cancer (MIBC).
- Data collected from 2017-2022 across nine cancer centers in a middle-income country.
- Analysis included descriptive statistics and Kaplan-Meier survival estimates.
Main Results:
- Of 343 patients, 217 had HR-NMIBC; only 29.5% received Bacillus Calmette-Guérin (BCG), with gemcitabine substitution due to shortages. BCG use correlated with better survival.
- In the MIBC cohort (n=126), 48.4% underwent cystectomy, improving survival. Perioperative chemotherapy was limited; cisplatin-based regimens offered the most benefit.
- Limited access to BCG, perioperative chemotherapy, and cystectomy were observed.
Conclusions:
- Significant gaps exist in localized UC management within middle-income settings.
- Barriers include limited access to BCG, perioperative chemotherapy, and cystectomy.
- Policy interventions are crucial to enhance treatment delivery and improve outcomes in comparable healthcare systems.
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