Bladder preservation vs. radical cystectomy for T2N0M0: trends and survival outcomes from SEER

To compare treatment trends and survival between bladder‑preserving (BP) therapy and radical cystectomy (RC) in patients with T2N0M0 muscle‑invasive bladder cancer (MIBC) using a large population‑based cohort.

This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) database (2010‑2022) to identify 10,495 patients with T2N0M0 MIBC. Temporal trends in treatment modalities (RC, trimodality therapy [TMT], partial cystectomy with chemotherapy [PC + CT], etc.) were analyzed. The primary outcomes were overall survival (OS) and cancer‑specific mortality (CSM). Propensity score matching (PSM) was used to compare OS and CSM between treatment groups. Fine‑Gray competing risk regression generated cumulative incidence curves and estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for CSM. Kaplan‑Meier estimation with log‑rank tests and multivariable Cox regression were also performed. All comparative survival results are reported with complete 95% CIs to quantify statistical uncertainty and avoid overinterpretation of non-significant findings.

From 2010 to 2022, the use of multimodal therapy increased. Specifically, TMT rose from 11.9% to 26.2%, and RC + CT increased from 8.9% to 23.9%, while monotherapies declined. After PSM, RC demonstrated superior 5-year OS compared to TMT (62.6% vs. 36.7%, p < 0.001). Notably, PC + CT showed no statistically significant 5-year survival differences relative to RC (OS: p = 0.893,HR = 0.97,95%CI(0.59-1.58); CSM: p = 0.902,HR = 1.04,95%CI(0.55-1.94)). Chemotherapy significantly improved survival for patients undergoing transurethral resection of bladder tumor (TURBT) and PC, but not RC. Multivariable analysis confirmed older age, female sex, and higher T-stage as risk factors, while chemotherapy and surgery (RC/PC) were protective.

This study reveals a significant shift towards multimodal therapy for T2N0M0 MIBC. Although RC remains associated with the best overall survival, PC + CT showed no statistically significant difference in OS or CSM compared with RC, supporting its potential as a BP option for carefully selected patients. Nevertheless, these findings are constrained by the limited sample size of the PC + CT cohort, the absence of functional and quality-of-life outcomes, and residual confounding inherent in the SEER database. The inferior survival of TMT in real-world practice underscores the critical importance of stringent patient selection for bladder preservation strategies.