Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 29;43(1):196.
doi: 10.1007/s00345-025-05566-9.

Optimizing treatment selection: outcomes of radical cystectomy in patients eligible for trimodal therapy

Maurin Helen Mangold #  1 , Malin Nientiedt #  2 , Frank Waldbillig  1 , Maurice Stephan Michel  1 , Nicolas Carl  1 , Britta Grüne #  1 , Maximilian Christian Kriegmair #  3
Affiliations

Optimizing treatment selection: outcomes of radical cystectomy in patients eligible for trimodal therapy

Maurin Helen Mangold et al. World J Urol. .

Abstract

Purpose: This study examines oncological and functional outcomes in a subset of patients eligible for trimodal therapy (TMT) within a large radical cystectomy (RC) cohort. It aims to determine whether TMT should be offered to all eligible patients, rather than exclusively to patients with significant comorbidities who are at high perioperative risk.

Methods: We conducted a retrospective analysis of 509 patients with urothelial carcinoma (pT1-pT4) who underwent RC between 2014 and 2020. Patients were divided into TMT eligible (n = 74), and TMT ineligible (n = 431) cohorts based on preoperative criteria. Key endpoints included blood loss, operative duration, urinary diversion type, adjuvant chemotherapy, and overall and progression-free survival (OS, PFS). Functional outcomes were assessed using validated quality of life (QoL) questionnaires.

Results: RC patients who were eligible for TMT demonstrated significantly better oncological outcomes, with higher overall survival (OS) (HR: 2.774, p < 0.001) and progression-free survival (PFS) (HR: 3.689, p < 0.001). They also experienced lower intraoperative blood loss (544.59 ml vs. 740.50 ml, p = 0.002) and were more likely to receive continent urinary diversion (55.1% vs. 38.8%, p = 0.01), with nearly 50% undergoing ileal neobladder reconstruction. Adjuvant chemotherapy was administered more frequently in the TMT-ineligible group (20.8% vs. 6.4%, p = 0.003). Apart from a significant difference in the positive support domain of the ISSS (p = 0.01), no significant differences in functional outcomes were observed.

Conclusion: TMT eligible patients undergoing RC have better oncological outcomes and more favourable perioperative parameters compared to TMT ineligible patients. These findings highlight the need for careful patient counselling when considering TMT as an alternative to RC. Future prospective studies are warranted to optimise treatment selection and functional outcome assessment in bladder cancer.

Keywords: Functional Outcomes; Perioperative and Oncological Outcomes; Radical Cystectomy; Trimodal Therapy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. The survey was approved by the institutional ethics review board of the Medical Faculty Mannheim, University of Heidelberg (proposal number: 2013-845R-MA). Consent to participate: Informed consent was obtained from all survey participants.

References

    1. Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, Fritsche HM et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163 - PubMed
    1. Khetrapal P, Wong JKL, Tan WP, Rupasinghe T, Tan WS, Williams SB et al (2023) Robot-assisted radical cystectomy versus open radical cystectomy: a systematic review and meta-analysis of perioperative, oncological, and quality of life outcomes using randomized controlled trials. Eur Urol 84(4):393–405 - PubMed
    1. Zlotta AR, Ballas LK, Niemierko A, Lajkosz K, Kuk C, Miranda G et al (2023) Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol 24(6):669–681 - PubMed
    1. Huddart RA, Birtle A, Maynard L, Beresford M, Blazeby J, Donovan J et al (2017) Clinical and patient-reported outcomes of SPARE—a randomised feasibility study of selective bladder preservation versus radical cystectomy. BJU Int 120(5):639–650 - PubMed - PMC
    1. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP et al (2017) Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol 198(3):552–559 - PubMed - PMC

LinkOut - more resources