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

Abstract Purpose: To compare the outcomes of trimodal therapy (TMT) and radical cystectomy (RC) in the treatment of muscle-invasive bladder cancer (MIBC). Methods: Patients treated with either TMT or RC for MIBC at our institution between January 1998 and December 2022 were included. Propensity score matching was used to compare cancer-specific survival and overall survival rates. Results: A total of 93 patients who underwent TMT and 84 who underwent RC for MIBC were analyzed. In the TMT cohort, the pathological complete response rate was 65%; the 5-year recurrence-free survival rate, including intravesical recurrence, was 41.1%; and the 5-year bladder intact event-free survival rate was 55.8%. 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 TMT and RC, respectively. Subgroup analyses revealed that TMT for primary tumors significantly improved cancer-specific survival rates compared with RC. The two treatment types had similar adverse events related to hematologic toxicity during perioperative chemotherapy. Conclusion: TMT exhibited oncological outcomes comparable to those of RC in the treatment of MIBC, indicating that TMT provides favorable outcomes, particularly in cases of primary MIBC.