Restricted accessResearch articleFirst published online 2025-11
Comparison of long-term survival for muscle-invasive bladder cancer patients who underwent bladder preservation therapy and radical cystectomy: A systematic review and meta-analysis
This study aims to compare BPT and RC for long-term survival and quality of life outcomes in MIBC patients.
Materials and methods:
The study conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, with search strategy across databases (PubMed, Scopus, Cochrane Library, EMBASE, and MEDLINE) used relevant keywords. RCTs, observational studies, and simulation studies were included. Each included study was evaluated with the Newcastle-Ottawa Scale (NOS) for observational studies and the Jadad score for randomized controlled trials (RCTs). Disagreements between reviewers were resolved by consensus, and inter-rater agreement was assessed using Cohen’s Kappa statistic. The meta-analysis was performed with Review Manager (RevMan), v5.4.
Results:
Seven studies (six retrospective cohorts, one RCT) met the inclusion criteria with a total of 25,212 patients. Analysis of four studies evaluating the comparison of BPT and RC showed no statistically significant differences in overall survival rates between the two therapies (HR = 1.14, 95%CI: 0.99–1.31, p = 0.07, I2 = 0%). Subgroup analysis results showed significant differences in overall mortality (HR = 1.16, 95%CI: 0.94–1.42, p = 0.17, I2 = 9%) and bladder cancer-specific mortality (HR = 1.11, 95%CI: 0.89–1.39, p = 0.34, I2 = 0%) between the two treatment approaches.
Conclusion:
Compared to RC, BPT generally demonstrated similar results in terms of survival, local recurrence-free survival, and disease-free survival. Treatment decisions should be individualized, considering patient preferences, tumor characteristics, and available resources.
WarliSMKadarDDSiregarGP. Ki-67 expression as a predictive factor of muscle invasion in bladder cancer. Open Access Maced J Med Sci2018; 6(2): 260–262.
2.
SiegelRLMillerKDWagleNS, et al. Cancer statistics, 2019. CA Cancer J Clin2019; 69(1): 17–34.
3.
WarliSMPrapiskaFFSiregarDIS, et al. Association between interleukin-6 levels and lymph node metastasis in bladder cancer patients. World J Oncol2022; 13(6): 365–369.
4.
WarliSMKadarDDSiregarGP, et al. The difference between cytokeratin 20 expression in high and low grade urothelial bladder carcinomas: A cross sectional study. Urol Ann2023; 15(4): 383–387.
5.
WarliSMPrapiskaFFSiregarDIS, et al. Prediction of locally advanced bladder tumor using preoperative clinical parameters. Urol Ann2023; 15(4): 412–416.
6.
WarliSMPrapiskaFFSiregarDIS, et al. Tumor markers as predictors of acute kidney injury incidence and staging of the muscle-invasive bladder cancer receiving chemoradiation therapy. World J Oncol2023; 14(5): 423–429.
7.
Alfred WitjesJLebretTCompératEM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol2017; 71(3): 462–475.
8.
ShariatSFKarakiewiczPIPalapattuGS, et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol2006; 176(6 Pt 1): 2414–2422.
9.
CompératELarréSRoupretM, et al. Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old. Virchows Arch2015; 466(5): 589–594.
10.
GaviFFoschiNFettucciariD, et al. Assessing trifecta and pentafecta success rates between robot-assisted vs. open radical cystectomy: a propensity score-matched analysis. Cancers2024; 16(7): 1270.
11.
HenningsohnLWijkströmHDickmanPW, et al. Distressful symptoms after radical radiotherapy for urinary bladder cancer. Radiother Oncol2002; 62(2): 215–225.
12.
RosarioDJBeckerMAndersonJB. The changing pattern of mortality and morbidity from radical cystectomy. BJU Int2000; 85(4): 427–430.
13.
PloussardGDaneshmandSEfstathiouJA, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol2014; 66(1): 120–137.
14.
ZlottaARBallasLKNiemierkoA, et al. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol2023; 24(6): 669–681.
15.
MitinTGeorgeAZietmanAL, et al. Long-term outcomes among patients who achieve complete or near-complete responses after the induction phase of bladder-preserving combined-modality therapy for muscle-invasive bladder cancer: a pooled analysis of NRG Oncology/rtog 9906 and 0233. Int J Radiat Oncol Biol Phys2016; 94(1): 67–74.
16.
ArcangeliGArcangeliSStrigariL. A systematic review and meta-analysis of clinical trials of bladder-sparing trimodality treatment for muscle-invasive bladder cancer (MIBC). Crit Rev Oncol2015; 94(1): 105–115.
17.
MakKSSmithABEidelmanA, et al. Quality of life in long-term survivors of muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys2016; 96(5): 1028–1036.
18.
ZlottaARBallasLKNiemierkoA, et al. Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol2023; 24(6): 669–681.
JadadARMooreRACarrollD, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?Control Clin Trials1996; 17(1): 1–12.
21.
HuddartRABirtleAMaynardL, et al. Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy. BJU Int2017; 120(5): 639–650.
22.
BekelmanJEHandorfEAGuzzoT, et al. Radical cystectomy versus bladder-preserving therapy for muscle-invasive urothelial carcinoma: examining confounding and misclassification biasin cancer observational comparative effectiveness research. Value Health2013; 16(4): 610–618.
23.
KimYJByunSJAhnH, et al. Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis. Oncotarget2017; 8(40): 68996–69004.
24.
SeisenTSunMLipsitzSR, et al. Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder. Eur Urol2017; 72(4): 483–487.
25.
ZhongJSwitchenkoJJegadeeshNK, et al. Comparison of outcomes in patients with muscle-invasive bladder cancer treated with radical cystectomy versus bladder preservation. Am J Clin Oncol2019; 42(1): 36–41.
26.
MohamedDOSayedMMAbdelkawiIF, et al. Bladder preservation versus radical cystectomy in transitional cell carcinoma and squamous cell carcinoma muscle invasive bladder cancer. Curr Urol2021; 15(1): 11–15.
27.
QiuJZhangHXuD, et al. Comparing long-term survival outcomes for muscle-invasive bladder cancer patients who underwent with radical cystectomy and bladder-sparing trimodality therapy: a multicentre cohort analysis. J Oncol2022; 2022: 1–11.
28.
ZaghloulMSChristodouleasJPZaghloulT, et al. Prospective trial of adjuvant therapy after radical cystectomy for locally advanced bladder cancer: analysis of the squamous cell carcinoma subgroup. In: Proceedings of the 2020 Genitourinary Cancers Symposium, San Francisco, CA, February 2020. Alexandria (VA): American Society of Clinical Oncology.
29.
NabilRAWarliSMSiregarGP, et al. Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis. Rep Pract Oncol Radiother2024; 29(1): 103–112.
30.
RussoPFoschiNPalermoG, et al. SIRI as a biomarker for bladder neoplasm: utilizing decision curve analysis to evaluate clinical net benefit. Urol Oncol Semin Original Investig2025; 43: 393.e1–393.e8.
31.
FahmyOKhairul-AsriMGSchubertT, et al. A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol2018; 36(2): 43–53.
32.
García-PerdomoHAMontes-CardonaCEGuachetaM, et al. Muscle-invasive bladder cancer organ-preserving therapy: systematic review and meta-analysis. World J Urol2018; 36(12): 1997–2008.
33.
WettsteinMSRoopraiJKPazhepurackelC, et al. Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer: does the current quality of evidence justify definitive conclusions?PLoS One2019; 14(4): e0216255.
34.
EfstathiouJASpiegelDYShipleyWU, et al. Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol2012; 61(4): 705–711.
35.
GrayPJFedewaSAShipleyWU, et al. Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol2013; 63(5): 823–829.
36.
BizzarriFPScarcigliaERussoP, et al. Elderly and bladder cancer: the role of radical cystectomy and orthotopic urinary diversion. Urologia2024; 91(3): 500–504.
37.
RussoPBizzarriFPFilomenaGB, et al. Relationship between loss of Y chromosome and urologic cancers: new future perspectives. Cancers2024; 16(22): 3766.
38.
DingHFanNNingZ, et al. Trimodal therapy vs. radical cystectomy for muscle-invasive bladder cancer: a meta-analysis. Front Oncol2020; 10: 564779.
39.
LagrangeJLBascoul-MolleviCGeoffroisL, et al. Quality of life assessment after concurrent chemoradiation for invasive bladder cancer: results of a multicenter prospective study (GETUG 97-015). Int J Radiat Oncol Biol Phys2011; 79(1): 172–178.
40.
PalermoGBizzarriFPScarcigliaE, et al. The mental and emotional status after radical cystectomy and different urinary diversion orthotopic bladder substitution versus external urinary diversion after radical cystectomy: a propensity score-matched study. Int J Urol2024; 31(12): 1423–1428.
