Numerous retrospective studies sought to identify appropriate selection criteria for TMT, but the strength and consistency of the supporting evidence remain moderate, with marked heterogeneity in study design, patient populations, and choices of statistical adjustments. Commonly cited criteria—such as tumor stage, hydronephrosis, and the presence of concomitant carcinoma in situ (CIS)—rely primarily on expert consensus rather than consolidated evidence.
In this systematic review and meta-analysis, we address this gap by synthesizing multivariable-adjusted data across a large body of literature. In the pooled analyses, worse overall survival after TMT was associated with both patient-related factors—such as older age, impaired renal function, and poor performance status—and tumor-related characteristics, including advanced T stage, nodal involvement, hydronephrosis, and concomitant carcinoma in situ. Worse cancer-specific survival was predominantly driven by tumor-related factors, particularly advanced T stage and the presence of hydronephrosis.
The value of this work lies in its direct relevance to daily clinical decision-making. The identified prognostic factors are readily available at diagnosis and can be integrated into shared decision-making when considering bladder preservation. Overall, this study provides a pragmatic, evidence-based framework for refining patient selection and setting realistic expectations for TMT in patients with MIBC.
Written by: Keiichiro Miyajima, Marcin Miszczyk, and Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria