Fahmy O, et al. - An in-depth assessment was conducted of the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (MIBC) with or without neoadjuvant chemotherapy (NAC). The findings unveiled comparable survival outcomes in patients after TMT and RC for MIBC. Improved survival was reported in patients who experienced downstaging after NAC and RC than the patients treated with RC only. A correlation was demonstrated between best survival outcomes after TMT with CR to this approach.

Methods

• Based on the PRISMA guidelines, a systematic search was pursued of the studies reporting on outcomes after TMT and RC.
• This research selected 57 studies comprising of 30,293 patients.
• An inspection was carried out of the 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC.

Results

• The data revealed that the mean 10-year OS was 30.9% for TMT and 35.1% for RC (P=0.32).
• The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P= 0.26).
• NAC was given prior to therapy for 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001).
• Complete response (CR) was reported in 1,545 (75.3%) of 2,051 patients treated with TMT.
• It was determined that a 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively.
• 2,416 (29.1%) out of 8,311 patients underwent downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC.
• A substantial rise was discovered in the rate of pT0 from 20.2% to 34.3% (P= 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3-4, through NAC.
• It was reported that a 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively.