Disparities in health care access and resource availability in middle-income countries often lead to suboptimal management of localized bladder urothelial carcinoma (UC). However, real-world data describing treatment patterns and outcomes in these settings remain limited.
This multicenter, retrospective, real-world study included patients with high-risk non-muscle-invasive (HR-NMIBC) and localized muscle-invasive bladder cancer (MIBC) diagnosed between 2017 and 2022 across nine cancer centers in a middle-income setting. Treatment data and clinical outcomes were collected from medical records and analyzed using descriptive statistics and Kaplan-Meier survival estimates.
Among 343 patients analyzed, 217 (63.3%) had HR-NMIBC, of whom only 29.5% received adjuvant Bacillus Calmette-Guérin (BCG), often substituted with intravesical gemcitabine because of supply shortages. BCG exposure was associated with superior overall and cancer-specific survival compared with non-BCG patients. In the muscle-invasive cohort (n = 126; 36.7%), cystectomy was performed in 48.4% and significantly improved survival. Perioperative chemotherapy remained limited, with only 39.3% receiving neoadjuvant therapy, and just one third receiving cisplatin-based regimens that conferred the greatest survival benefit.
This multicenter real-world study exposes major gaps in the management of localized UC in a middle-income setting. Limited access to BCG, perioperative chemotherapy, and cystectomy remain key barriers to guideline-concordant care, underscoring the urgent need for policy actions to improve treatment delivery and outcomes in comparable health care systems.
JCO global oncology. 2026 Apr 29 [Epub]
André Paternò Castello Dias Carneiro, Elice Carneiro Batista, Diogo Diniz Gomes Bugano, Rodrigo Guimarães Corradi, Renato Panhoca, João Antonio Soler, Eduardo Carvalhal, Andréa Lopes Ponte de Souza, Bruna Motke, Henrique Alkalay Helber, Bruna Dos Santos Sampaio, Frederico Monfardini, Silvia Regina Lamas Assis, Viviane Aparecida Rodrigues Sant'Anna, Gustavo Prado Dos Santos, Mayla Lopes da Silva, Flávia Miranda Duarte, Mariane Pereira, Diogo Duarte Fagundes Moia, Ronaldo Vicente Pereira Soares, Arie Carneiro, Guilherme Fleury Perini, Luiz Vicente Rizzo, Fernando Cotait Maluf
Hospital Israelita Albert Einstein, São Paulo, Brazil., Hospital Mario Penna, Belo Horizonte, Brazil., Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil., Fundação Faculdade Regional de Medicina de São José do Rio Preto-CIP São José, São José do Rio Preto, Brazil., Hospital Moinhos de Vento, Porto Alegre, Brazil., Instituto de Medicina Integral Professor Fernando Figueira-IMIP, Recife, Brazil., Irmandade da Santa Casa de Misericórdia de Porto Alegre-ISCMPA, Porto Alegre, Brazil.