Trimodal therapy (TMT)-comprising transurethral resection of the bladder tumor, chemotherapy, and radiotherapy-offers a bladder-preserving alternative to radical cystectomy for selected patients with muscle-invasive bladder cancer (MIBC).
However, the optimal criteria for patient selection and prognostication remain inadequately defined. A systematic review and meta-analysis was conducted to optimize the selection of MIBC patients who are likely to have better survival outcomes from TMT.
A systematic literature search was conducted in MEDLINE, Embase, and Web of Science in February 2025. Eligible studies examined prognostic factors for overall or cancer-specific survival in patients with MIBC undergoing TMT. To reduce the impact of confounding, only multivariable-adjusted estimates were included in the meta-analysis. Pooled hazard ratios (HRs) were calculated using a random-effect model. The risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool (CRD42025641514).
A total of 31 studies, including 9416 patients treated with TMT for MIBC, met the inclusion criteria. Older age (per year increase; HR: 1.03, 95% confidence interval [CI]: 1.01-1.05), poor performance status (Eastern Cooperative Oncology Group ≥2 vs 0-1; HR: 2.47, 95% CI: 1.78-3.43), impaired renal function (HR: 1.47, 95% CI: 1.12-1.92), presence of hydronephrosis (HR: 1.65, 95% CI: 1.17-2.34), advanced T stage (HR: 1.47, 95% CI: 1.23-1.77), nodal involvement (HR: 1.90, 95% CI: 1.10-3.30), and concomitant carcinoma in situ (HR: 1.81, 95% CI: 1.02-3.20) were independently associated with worse overall survival. Limitations included heterogeneity in treatment protocols and potential residual confounding across studies.
Specific patient- and tumor-related factors are significantly associated with prognosis in patients undergoing TMT for MIBC. These findings may aid in refining patient selection and risk stratification for TMT-based bladder-preserving approaches.
European urology focus. 2025 Dec 18 [Epub ahead of print]
Keiichiro Miyajima, Akihiro Matsukawa, Takafumi Yanagisawa, Marcin Miszczyk, Navid Roessler, Shota Inoue, Shingo Nishimura, Abdulrahman S Alqahtani, Ahmed R Alfarhan, Fumihiko Urabe, Keiichiro Mori, Pierre I Karakiewicz, Leonardo Oliveira Reis, Takahiro Kimura, Shahrokh F Shariat
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Ministry of Health, Second Health Cluster, Riyadh, KSA., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Prince Saud Bin Jalawi Hospital, Al Ahsa Health Cluster, Al Ahsa, the Kingdom of Saudi Arabia., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., UroScience and Department of Surgery (Urology), School of Medical Sciences, University of Campinas, Unicamp, São Paulo, Brazil; Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41419363