Prospective cohort study of radical cystectomy versus bladder-sparing therapy for recurrent high-grade NMIBC: twelve-month results

The prospective, observational CISTO (‘Comparison of Intravesical therapy and Surgery as Treatment Options’) cohort study, at 36 centers in the United States, compared patient-reported and clinical outcomes between radical cystectomy (RC) and bladder-sparing therapy (BST) in patients with recurrent high-grade non-muscle-invasive bladder cancer (NMIBC). Eligible adult patients were candidates for both RC or BST, had previous induction Bacillus Calmette-Guérin, and received their last treatment within 12 months. Among 570 participants, 371 selected BST and 199 selected RC. The primary outcome was EORTC-QLQ-C30 physical function scale at 12 months. For this outcome, there was no difference between the two groups (average treatment effect 0.9; p=0.22). RC was associated with better emotional function, generic health-related quality of life, and financial burden, and lower depression and anxiety, while BST was associated with better bowel and sexual health. Cancer-specific survival was 99% for BST versus 96% for RC (weighted risk ratio 0.99; 95% CI 0.97-1.01). RC was associated with a higher risk of adverse events and serious adverse events, including an 90-day mortality rate of 2.5%. The authors conclude that these findings support the continued role of RC in managing recurrent high-grade NMIBC.