Retrospective analysis of radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer

Previous randomized controlled trials comparing bladder preservation versus radical cystectomy for muscle-invasive bladder cancer (MIBC) closed due to insufficient accrual. A retrospective propensity score matched (PSM) and weighted (IPTW) analysis of patients of three tertiary center in the USA and Canada compared results of MIBC patients undergoing trimodality therapy (maximal transurethral resection followed by concurrent chemoradiation) of radical cystectomy. There were no significant differences in oncological outcomes between the groups, while overall survival favored trimodality therapy (IPTW: HR 0.70; p=0.010 and PSM: HR 0.75; p=0.0078). The authors conclude that trimodality therapy should be offered to all suitable MIBC patients and not only to patients with significant comorbidities for who surgery is not an option.