Radical Surgery Compared to Bladder-Preserving Approaches for Limited Stage Small-Cell Bladder Cancer: Systematic Review and Meta-Analysis.

Abstract

Background and objective: Small-cell bladder cancer (SCBC) is an aggressive and rare malignancy for which there is no clear optimal treatment strategy. This systematic review and meta-analysis aimed to compare the median overall survival (OS) of patients with limited-stage (LS) SCBC treated with either cystectomy-based multimodal therapy (CBMMT) or radiation-based multimodal therapy (RBMMT).

Methods: A comprehensive search of PUBMED, Embase, and Scopus databases was performed for studies published before January 2024 according to the PRISMA guidelines. Studies have assessed LS-SCBC disease and provided survival data for subgroups of patients undergoing radical surgery or bladder-preserving approaches to be deemed eligible. Data extraction and quality assessment were independently conducted by 2 authors.

Key findings and limitations: Five studies comprising 1041 patients were analyzed. The pooled median OS for patients receiving RBMMT was 34.6 months (95% CI, 25.5-43.7), compared to 29.7 months (95% CI, 18.2-41.1) for those undergoing CBMMT. The main limitations are the retrospective nature of the included studies and the potential bias.

Conclusions and clinical implications: This meta-analysis indicates that RBMMT may provide comparable outcomes to CBMMT in LS-SCBC patients, supporting the consideration of bladder-preserving approaches in selected cases. RBMMT may offer a potential clinical benefit in terms of organ preservation for appropriately selected patients, although survival differences were not statistically significant.