To compare 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).
This pragmatic, prospective observational cohort study was designed with patients, who selected and prioritized outcomes. Eligible adults were candidates for both RC or BST, had previous induction Bacillus Calmette-Guérin (BCG), and received their last treatment within 12 months. The primary outcome was the EORTC-QLQ-C30 physical function scale at 12 months. Secondary outcomes included other EORTC-QLQ-C30 scales, depression, anxiety, bladder cancer-specific quality of life (QOL), financial burden, and cancer-specific outcomes. Targeted maximum likelihood estimation (TMLE) was used to calculate average treatment effect (ATE) estimates between arms. Inverse probability weighted risk ratios (wRR) were calculated using quasi-Poisson regression.
Of 570 participants (mean age 71.4 years; 21% female), 371 selected BST and 199 selected RC. Physical function was significantly worse in the RC arm at 3 months; by 9 months, there was no difference between arms, and at 12 months, physical function did not differ (ATE, 0.9; 95% CI, -0.6 to 2.4; P = .22). RC was associated with better emotional function, generic health-related QOL, 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 (wRR, 0.99; 95% CI, 0.97 to 1.01). RC was associated with a higher risk of adverse events and serious adverse events, including a 90-day mortality rate of 2.5%.
Most patient-prioritized outcomes were similar or better among participants who chose RC compared with BST. These findings support the continued role of RC in managing recurrent high-grade NMIBC.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2025 Dec 15 [Epub ahead of print]
John L Gore, Erika M Wolff, Michael G Nash, Bryan A Comstock, Scott M Gilbert, Sam S Chang, Stephanie Chisolm, Douglas B MacLean, Jonathan L Wright, Max R Kates, Kamal S Pohar, Thomas J Guzzo, Trinity J Bivalacqua, Kenneth G Nepple, Jeffrey S Montgomery, Kristen R Scarpato, Solomon L Woldu, Viraj A Master, David Y T Chen, Matthew Mossanen, Siamak Daneshmand, Brock B O'Neil, Mark D Tyson, Mary E Westerman, Ashish M Kamat, Ahmed M Mansour, Karim Chamie, Stephen B Riggs, Janet B Kukreja, Parth K Modi, Tullika Garg, Charles C Peyton, Jeffrey W Nix, Rian Dickstein, Adam J Gadzinski, Alex Sankin, Neal D Shore, Brian R Lane, Jeffrey C Bassett, Sanjay Patel, David S Morris, Liam C Macleod, Eugene K Lee, Chad R Ritch, Kristin M Follmer, Jenney R Lee, Sung Min Kim, Larry G Kessler, Angela B Smith, CISTO Collaborative group
Department of Urology, University of Washington, Seattle, WA., Department of Biostatistics, University of Washington, Seattle, WA., Department of Genitourinary Oncology, H. Lee Moffit Cancer Center and Research Institute, Tampa, FL., Department of Urology, Vanderbilt University Medical Center, Nashville, TN., Bladder Cancer Advocacy Network, Bethesda, MD., CISTO Advocate Advisory Board, Seattle, WA., Department of Urology, The James Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD., Department of Urology, The Ohio State University, Columbus, OH., Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Department of Urology, University of Iowa, Iowa City, IA., Department of Urology, Michigan Medicine, Ann Arbor, MI., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology and Winship Cancer Institute, Emory University, Atlanta, GA., Department of Urology, Fox Chase Cancer Center, Philadelphia, PA., Brigham and Women's Hospital, Boston, MA., Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT., Department of Urology, Mayo Clinic, Scottsdale, AZ., Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Department of Urology, University of Texas Health, San Antonio, TX., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC., Department of Urology, University of Colorado, Denver, CO., Section of Urology, Department of Surgery, University of Chicago, Chicago, IL., Department of Urology, Geisinger Health System, Danville, PA., Department of Urology, University of Alabama, Birmingham, AL., Chesapeake Urology, Baltimore, MD., Comprehensive Urology, Royal Oak, MI., Department of Urology, Montefiore Medical Center and Albert Einstein School of Medicine, Bronx, NY., Carolina Urologic Research Center, Myrtle Beach, SC., Division of Urology, Corewell Health West, Grand Rapids, MI., Department of Urologic Oncology, Hoag Memorial Presbyterian Hospital, Newport Beach, CA., Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK., Urology Associates, PC, Nashville, TN., Department of Urology and Heiman Cancer Center, Asante Rogue Regional Medical Center, Medford, OR., Department of Urology, University of Kansas Medical Center, Kansas City, KS., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL., Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA.