Prognostic Factors in Advanced Bladder Cancer: A Real-World Retrospective Analysis

Introduction: Metastatic bladder cancer (mBC) is associated with poor outcomes.Despite advances in immunotherapy and targeted agents, platinum-based chemotherapy remains a cornerstone of treatment in real-world practice.We aimed to identify pragmatic and readily available prognostic factors for risk stratification in patients with mBC.Methods: This retrospective multicenter study included 121 patients with mBC treated at two high-volume oncology centers.Clinicopathological and laboratory parameters at the time of metastatic diagnosis were analyzed.The primary endpoint was overall survival (OS).Results: The median age was 66 years, and 90% of patients were male.The most common metastatic sites were abdominal lymph nodes (71.9%), bone (52.9%), lung (41.3%), and liver (27.3%).On multivariable analysis, Eastern Cooperative Oncology Group Performance Status ≥2 (hazard ratio [HR] 1.80 (1.04-3.14),p=0.036), low hemoglobin (HR 1.67 (1.01-2.77),p=0.046), hypoalbuminemia (HR 2.08 (1.24-3.50),p=0.006), and leukocytosis (HR 2.26 (1.32-3.87),p=0.003) were independently associated with inferior OS. Discussion and Conclusion: Poor performance status, low hemoglobin levels, hypoalbuminemia, and leukocytosis at metastatic diagnosis are independent predictors of worse survival.These simple, cost-effective parameters may support risk stratification and clinical decision-making, particularly in settings where access to novel therapies is limited.Keywords: Hypoalbuminemia; leukocytosis; metastatic bladder cancer; overall survival; prognostic factors; real-world data. B ladder cancer (BC) represents an aggressive malignancy,typically diagnosed at a median age of around 73 years.Histologically, urothelial carcinoma represents the predominant subtype of BC [1] .At initial presentation, approximately one-third of patients have muscle-invasive BC, whereas de novo metastatic disease is identified in a smaller subset, comprising about 5% of cases.Moreover, among those initially diagnosed with non-metastatic disease, an estimated 20-25% will subsequently progress to metastatic disease during the course of follow-up.Despite advances in systemic therapies, clinical outcomes remain suboptimal, with median progression-free