Patient Journey and Treatment Patterns of Non-Muscle-Invasive Bladder Cancer in Mexico

Non-muscle-invasive bladder cancer (NMIBC) accounts for most newly diagnosed bladder tumors, yet little is known about how it is managed in Mexico, particularly during prolonged Bacillus Calmette-Guérin (BCG) shortages. This retrospective, multicenter observational study characterized the clinical and histopathological profile, the diagnostic and treatment timelines, and the adherence to guideline-recommended care of patients with NMIBC treated at three tertiary referral hospitals in Mexico City. The records of 221 adults diagnosed between January 2010 and December 2020 were reviewed, and the risk of recurrence or progression was classified according to the European Association of Urology 2019 classification. The median age was 68 years (interquartile range [IQR] 59-75) and the male-to-female ratio was 3:1. Hematuria was the most frequent presenting symptom (83.3%). Three-quarters of patients had T1 tumors, 6.3% had concomitant carcinoma in situ, 84.6% had high-grade tumors, and 92.8% were at high risk of recurrence or progression. The median interval from symptom onset to histopathologic diagnosis was 167 days (IQR 81-329) and varied between centers. After diagnosis, the median time to second-look resection was 67 days (IQR 33.5-112) and to the first BCG instillation 92.5 days (IQR 41.8-165.5). Adjuvant intravesical therapy was administered to 66% of patients, most often BCG, although fewer than half of the BCG-treated patients (45%) completed induction, and 40% of the patients eligible for a second-look transurethral resection did not undergo it. Thirty percent of patients had no documented post-treatment surveillance. These real-world data provide a baseline description of NMIBC care in Mexican tertiary centers and identify specific, measurable gaps that may inform standardization and quality-improvement efforts in resource-constrained settings.