INTRODUCTION I² 29.8%). This adverse effect was consistent across treatment modalities, including definitive chemoradiotherapy (HR 1.74, 95% CI 1.30-2.32; I² 34%), radiotherapy alone (HR 1.65, 95% CI 0.38-7.19; I² 0%), and trimodality therapy (HR 1.64, 95% CI 1.25-2.14; I² 39.6%), with no evidence of subgroup interaction (p = 0.93). Hydronephrosis was also associated with worse cancer-specific survival (HR 2.00, 95% CI 1.68-2.37; I² 8.9%). Disease control endpoints were consistently inferior in patients with hydronephrosis, including disease-free survival (HR 1.83, 95% CI 1.12-3.01; I² 48.7%), progression-free survival (HR 1.59, 95% CI 1.02-2.49; I² 0%), and metastasis-free survival (HR 1.56, 95% CI 1.32-1.84; I² 0%). The overall risk of bias across included studies was predominantly moderate. CONCLUSIONS: Pretreatment hydronephrosis is a robust, treatmentindependent adverse prognostic factor in radiotherapy-based bladder-preserving management of muscle-invasive bladder cancer, conferring consistently increased hazards for mortality and disease progression across all major oncologic endpoints. Its presence should be systematically integrated into baseline prognostic stratification, patient counseling, and risk-adapted surveillance strategies in bladder-preserving treatment paradigms.
Nasution et al. (Fri,) studied this question.