Radical cystectomy (RC) and trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) offer similar oncologic outcomes, according to study findings presented at the 2022 European Association of Urology Congress in Amsterdam, The Netherlands.

In a propensity-score matched comparison of 834 RC patients and 282 TMT recipients, the 5-year probabilities of metastasis-free survival (the primary study outcome) were 78% for TMT and 73% for RC in adjusted analyses, a nonsignificant difference between the treatment approaches. The study, which included patients from Princess Margaret Cancer Centre in Toronto, Ontario, Massachusetts General Hospital in Boston, and the University of Southern California in Los Angeles, also revealed no significant difference between centers, thereby supporting the generalizability of the finding.

“This large multi-institutional contemporary study provides the best evidence to date, in the absence of randomized trials, supporting trimodality therapy for select patients with muscle-invasive bladder cancer,” Alexandre R. Zlotta, MD, of The Princess Margaret Cancer Centre, concluded during an oral presentation.

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He and his collaborators concluded that TMT should not be reserved only for patients who are not surgical candidates.

Dr Zlotta noted that TMT — a combination of maximal transurethral resection of bladder tumor following by concurrent chemotherapy and radiation therapy — is not widely used. It is often restricted to patients for whom surgery is not an option because they have significant comorbidities. One reason for the limited use of TMT, he noted, is the lack of research comparing it with RC. Previous randomized studies all ended due to lack of patient accrual.

In the matched cohort, the median age was 71 years, 75% were male, 90% had cT2 cancer, 60% received adjuvant or neoadjuvant chemotherapy, and 10% had hydronephrosis.

In the TMT group, 13% required salvage cystectomy and 20.5% experienced recurrence of nonmuscle-invasive bladder cancer.


Zlotta AR, Ballas LK, Niemierko A, et al. Propensity matched comparison of radical cystectomy with trimodality therapy for muscle invasive bladder cancer (MIBC): A multi-institutional study. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0762.