4621 Background: TMT (maximal TURBT followed by chemoradiation) is typically reserved for bladder cancer (BC) patients with solitary tumors less than 6 cm, no extensive carcinoma in situ, and no or unilateral hydronephrosis. The National Comprehensive Cancer Network (NCCN) guidelines specify that optimal candidates for bladder preservation with chemoradiotherapy have tumors less than 6 cm; larger tumors are less likely to be completely resected and have poorer local control and survival outcomes with bladder-sparing approaches. We aimed to analyze outcomes of BC patients receiving multimodal therapy and further categorizing outcomes of RC versus TMT based on tumor sizes. Methods: We analyzed patients with T1–T4, N0–N3, M0 urothelial carcinoma of the bladder using the NCDB (2010–2022). Patients were grouped as: RC, neoadjuvant chemotherapy (NAC) plus RC, RC followed by adjuvant chemotherapy (AC), and TMT. Overall survival (OS) was estimated with Kaplan–Meier methods and multivariable Cox regression adjusted for common confounders for these four groups. We also further analyzed the role of tumor size for patients who received either RC or TMT. Tumor size was divided in three groups; less than 3cm, 3 to 6cm, and more than 6cm. Results: Among 33,836 patients (median age 68y), treatment groups were as follows: RC alone (34%), NAC-RC (23%), RC-AC (21%) and TMT (22%). BC specific prognostic factors like tumor size more than 6cm vs 3cm (HR 1.70 (1.62–1.77) (p 6cm) RC provided no significant OS benefit over TMT. This suggests that the inherent aggressiveness of large lesions overrides any surgical advantage. Therefore, BPS must be strongly considered for tumors > 6cm when other TMT contraindications (e.g., hydronephrosis) are absent.
Syed et al. (Wed,) studied this question.