TURBT versus RC in T1N0M0 non-urothelial bladder cancer: a population-based study

This study aims to compare overall survival (OS) and cancer-specific survival (CSS) between transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) in patients with T1N0M0 non-urothelial bladder cancer (NUBC). Additionally, it seeks to identify prognostic factors that can guide individualized treatment for this rare malignancy.

We conducted a retrospective analysis of patients with pathologically confirmed T1N0M0 NUBC using the SEER database (2004-2017). Patients were categorized by their most definitive surgical treatment: TURBT alone or RC. A 1:3 nearest-neighbor propensity score matching (PSM) without replacement was performed to balance baseline covariates between the two groups. OS and CSS were then compared between the matched cohorts.

Among 828 eligible patients (698 TURBT, 130 RC), significant differences in histology and treatment were observed. Following PSM, 496 patients (366 TURBT, 130 RC) were analyzed. The RC group demonstrated significantly superior 1-, 3-, and 5-year OS and CSS rates (OS: P<0.001; CSS: P=0.002). Multivariable Cox analysis identified neuroendocrine carcinoma, squamous cell carcinoma, and TURBT as independent risk factors for poorer prognosis, while RC was associated with improved survival (OS: HR=0.56, 95% CI 0.42-0.74, P<0.001; CSS: HR=0.48, 95% CI 0.32-0.72, P<0.001). Neuroendocrine and squamous cell carcinomas were associated with poorer OS than adenocarcinoma (P=0.002 and P<0.001, respectively). Married patients exhibited superior OS compared to single, divorced, widowed, or separated (SDWS) patients (P=0.003). Subgroup analyses generally favored RC, although survival differences were not statistically significant in specific subsets. For OS, these included patients aged <65 (P=0.120), male (P=0.071), low/intermediate grade (P=0.400), married (P=0.064), other histology (P=0.700), and SDWS (P=0.066). For CSS, these included patients aged <65 (P=0.120), low/intermediate grade (P=0.420), high grade (P=0.080), squamous cell carcinoma (P=0.170), other histology (P=0.690), SDWS (P=0.051), and non-first primary tumor (P=0.970).

For patients with T1N0M0 NUBC, RC is associated with significantly improved survival outcomes compared to TURBT as definitive surgical management, with the greatest benefit observed in high-risk subtypes such as neuroendocrine and squamous cell carcinoma. However, this survival advantage must be carefully weighed against the substantial morbidity of RC and the potential for overtreatment. These findings support a risk-adapted, shared decision-making approach within a multidisciplinary framework, rather than a universal recommendation for RC in all T1N0M0 NUBC patients.