Trends and outcomes of bladder cancer treatment over the past decade

Background: Radical cystectomy (RC) is effectively used for urothelial bladder cancer, however, the risk of recurrence remains high necessitating the search for the new treatment approaches. The aim of this study is to analyze the impact of pre- and postoperative treatments on 10-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) in patients diagnosed with bladder cancer (BC).

Materials and methods: This retrospective single-center cohort study included the surgical treatment outcomes of 484 patients with confirmed BC diagnosis (cTis-4N0–3) who underwent cystectomy between 2012 and 2021. The final analysis included 455 cases, with a median age of 65 years, and the majority being male (82.6 %). Prior radiation therapy (RT) was administered to 6.4 % of patients, BCG therapy to 5.9 %, and neoadjuvant therapy (NT) to 23.5 %. Among postoperative treatments, only adjuvant systemic therapy (AT) in 49 patients (10.8 %) was considered. The study protocol was approved by the Biomedical Ethics Committee (No. 32 / 355, dated December 23, 2020).

Results: Three key trends were identified over the past 10 years. First, the number of NT prescriptions increased by more than 50 %, mainly due to platinum-based regimens and immuno-oncological agents; however, such regimens were rarely used in patients over 75 years old. Second, prior definitive RT was found to be a significant risk factor for recurrence (OR 2.84, p < 0.001), while NT and AT did not impact survival due to the limited number of cases. Third, surgical treatment after RT was not limited to laparoscopic access and did not lead to an increase in positive surgical margins (detected in only one case, 3.4 %).

Conclusions: Our study revealed that definitive radiation therapy negatively affects oncological outcomes and increases the risk of recurrence after radical cystectomy, emphasizing the need for a cautious approach when selecting treatment for such patients.

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