Comparison of prognosis between primary and progressive muscle-invasive bladder carcinoma: A prospective analysis of long-term outcomes after radical cystectomy

Introduction

Up to 15% of muscle-invasive bladder cancers (MIBC) arise from the progression of a non-muscle-invasive neoplasm. Despite sharing similar treatment strategies, the literature reports differences in survival rates between these two groups. This study aims to identify differences in recurrence and survival that may influence individualized treatment approaches.

Material and methods

Prospective study of cystectomies performed for MIBC between 2011 and 2023, collecting demographic, diagnostic, treatment, and recurrence data (local, urothelial, or distant). A comparative and multivariate analysis was conducted.

Results

We did not observe significant differences in recurrence rates between primary and progressive MIBC. However, the group with progression showed better overall survival (OS) rates at 2, 5 and 10 years (100%, 90%, 55%) compared to the primary (80%, 55%, 35%; p = 0.012), as well as better cancer-specific survival (CSS) (100%, 100%, 95% vs. 85%, 77%, 65%; p = 0.033). Independent risk factors for recurrence include pN+ (OR: 3.72) and lymphovascular invasion (LVI) (OR: 5.53). Predictors of lower OS include age, nodal involvement, LVI and relapse at any level. For CSS, predictors include nodal involvement, LVI and relapse at any level.

Conclusions

In our series, patients with progressive MIBC have better OS and CSS. For both groups, pN + and LVI are independent risk factors for recurrence. Nodal involvement, LVI and relapse at any level are predictors of poorer OS and CSS.