В мире урологии произошел переход от радикальной цистэктомии к комбинированной терапии при раке мочевого пузыря

From 2010 to 2022, treatment of T2N0M0 muscle‑invasive bladder cancer (MIBC) has shifted from radical cystectomy to multimodal therapy, according to findings published in the World Journal of Urology. Radical cystectomy has been the gold-standard treatment for MIBC for decades and is still associated with the best overall survival (OS). However, more patients are interested in bladder-preserving treatment options. “Our analysis delineates a definitive shift in T2N0M0 MIBC management from monotherapy toward multimodal strategies, marked by a substantial decline in TURBT or [radical cystectomy] alone and a concurrent rise in combined regimens, particularly [trimodal therapy] and [radical cystectomy plus chemotherapy],” the study investigators wrote. Investigators sought to understand real-world treatment trends in T2N0M0 MIBC since 2010 and analyzed data from 10,495 patients in the Surveillance, Epidemiology, and End Results (SEER) database. All patients were diagnosed with T2N0M0 MIBC from 2010 to 2022 and assessed for OS and cancer-specific mortality (CSM) by treatment modality. Investigators used a propensity score matching approach to balance cohort differences. The study population was 72.5% male. Overall, 52.7% of the cohort was 73 years or older; 86.6% were White; 52.3% were diagnosed from 2010 to 2016; and 69.4% were diagnosed with T2NOS stage. The patients underwent transurethral resection of bladder tumor (TURBT; 71.4%), 52.9% received chemotherapy, and 25.6% received radiation. Trimodality therapy was the most common multimodal therapy (18.5%), followed by radical cystectomy with chemotherapy (17.3%), TURBT with chemotherapy (15.7%), TURBT with radiotherapy (6.5%), and partial cystectomy plus chemotherapy (1.0%). Over time, use of bladder-preserving therapies remained relatively stable, from a low of 69.3% in 2018 to a high of 77.6% in 2011. Use of chemotherapy and radiotherapy increased consistently, from 35.6% and 19.9% in 2010, respectively, to 66.7% and 32.4% in 2021, respectively. Among bladder-preserving strategies, trimodality therapy use increased from 11.9% in 2022 to 26.2% in 2021. In contrast, use of TURBT alone decreased from 40.4% in 2011 to 22.7% in 2021. At 5 years, the OS rate was higher with trimodality therapy than with TURBT with chemotherapy (32.3% vs 30.5%; P <.001). However, OS was superior with both radical cystectomy (62.6%; P <.001) and partial cystectomy plus chemotherapy (68.3%; P <.001). Adding chemotherapy to the treatment strategy improved OS regardless of modality. Similarly, adding chemotherapy to partial cystectomy or TURBT significantly improved 5-year CSM for both modalities. On multivariate analysis, predictors for worse CSM included age 73 years or older (hazard ratio [HR], 1.43; 95% CI, 1.34-1.52; P <.001), female gender (HR, 1.23; 95% CI, 1.15-1.32; P <.001), T2b stage (HR, 1.37; 95% CI, 1.22-1.53; P <.001), and T2NOS (HR, 1.14; 95% CI, 1.05-1.24; P =.003). Better CSM associated with radical cystectomy (HR, 0.33; 95% CI, 0.30-0.36; P <.001), partial cystectomy (HR, 0.47; 95% CI, 0.38-0.58; P <.001), chemotherapy (HR, 0.76; 95% CI, 0.71-0.81; P <.001), radiotherapy (HR, 0.82; 95% CI, 0.78-0.86; P <.001), diagnosis in 2017 or after (HR, 0.86; 95% CI, 0.80-0.92; P <.001), and married marital status (HR, 0.89; 95% CI, 0.86-0.93; P <.001). This study was limited by not having access to important data, such as performance status, comorbidities, surgical margins, and chemotherapy or radiotherapy treatment details. “[Radical cystectomy] was associated with superior overall survival compared to [bladder-preserving] approaches,” investigators wrote. “However, it is noteworthy that [partial cystectomy plus chemotherapy] exhibited statistically nonsignificant survival differences relative to [radical cystectomy], suggesting its potential as an effective BP strategy in selected patients. “The inferior real-world survival of [trimodal therapy] compared to [radical cystectomy] underscores a critical efficacy-effectiveness gap, emphasizing that the success of bladder preservation is contingent upon stringent patient selection and standardized treatment protocols to ensure oncologic safety.” No funding support is listed for this study, and study authors reported no conflicts of interest. Please see the original reference for full disclosures. References: He Q, Jiang Z, Jiang C, Tu X, Huang J. Bladder preservation vs. radical cystectomy for T2N0M0: trends and survival outcomes from SEER. World J Urol. 2026;44(1):575. doi:10.1007/s00345-026-06683-9