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.

Objective/purpose: 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.