Comparison of trimodal therapy versus radical cystectomy for each stage of muscle-invasive bladder cancer

Purpose: Radical cystectomy (RC) has long been the standard of care for the management of muscle-invasive bladder cancer (MIBC). However, an increasing trend of bladder-sparing trimodal therapy (TMT) using maximal transurethral resection of bladder tumor, followed by radiation therapy (RT) with concomitant radiosensitizing chemotherapy, has been advocated. We compared the differences regarding long-term oncological outcomes between patients who accepted RC or TMT for MIBC. Materials and Methods: Between January 2012 and December 2018, 207 patients were diagnosed with MIBC at our center. We excluded patients with metastasis disease, received other treatments, and lost to follow-up. The patients were categorized into Group 1 (TMT) and Group 2 (RC). Both the groups with each tumor stage were compared for disease-free survival (DFS) and overall survival (OS) rates, and the risk factors for recurrence and survival were assessed. Results: In total, 58 (48.7%) patients in Group 1 underwent TMT and 61 (51.3%) patients in Group 2 underwent RC. The mean follow-up was 39.8 months. The 3-year DFS rates were 44.1% and 69.7% for Groups 1 and 2, respectively (P = 0.003). The 3-year OS rates were 61.7% and 72.5% for Groups 1 and 2, respectively (P = 0.226). We also analyzed the DFS with each stage, and the results showed a lower DFS rate for T2 and N0 stages. Conclusion: There was no significant survival benefit for MIBC with either RC or TMT. However, RC is associated with better outcome of DFS rate, especially for patients with early stages of MIBC in stages T2 and N0.