Comparative analysis of oncological outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer utilizing propensity score matching

Background: Bladder preservation therapy for muscle-invasive bladder cancer is reported to yield outcomes comparable to those of radical cystectomy, although it receives a relatively low recommendation grade in Japanese guidelines. This study aims to compare the outcomes of trimodal therapy versus radical cystectomy in the treatment of muscle-invasive bladder cancer. Methods: This study is a single-center retrospective analysis that included patients treated with either trimodal therapy or radical cystectomy for muscle-invasive bladder cancer (cT2-4N0-2M0) at our institution between January 1998 and December 2022. Trimodal therapy is administered in cases where radical cystectomy is either unfeasible or declined by the patient, and both treatments are performed with the intent of curative outcomes. Propensity score matching was used to compare cancer-specific survival and overall survival rates. Results: A total of 93 patients who underwent trimodal therapy and 84 who underwent radical cystectomy for muscle-invasive bladder cancer were analyzed. Using propensity score matching, 66 patients from each treatment group were selected for a comparative analysis of oncological outcomes. The 5-year distant metastasis-free, cancer-specific and overall survival rates were 64.3 and 51.8% (P = 0.096), 83.3 and 69.2% (P = 0.104) and 77.8 and 64.2% (P = 0.274) for trimodal therapy and radical cystectomy, respectively. Subgroup analyses revealed that trimodal therapy for primary tumors significantly improved cancer-specific survival rates compared with radical cystectomy. The two treatment types had similar adverse events related to hematologic toxicity during perioperative chemotherapy. Conclusion: Trimodal therapy exhibited oncological outcomes comparable to those of radical cystectomy in the treatment of muscle-invasive bladder cancer, indicating that trimodal therapy provides favorable outcomes, particularly in cases of primary muscle-invasive bladder cancer.