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dr swati shah - uro & gynec cancer surgeon
dr swati shah - uro & gynec cancer surgeon
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Surgery Shows Better Survival Than Trimodal Therapy in Rare Bladder Cancers

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Surgery Shows Better Survival Than Trimodal Therapy in Rare Bladder Cancers

Most bladder cancers are urothelial type, but some patients have less common forms, like squamous cell carcinoma (SCC), neuroendocrine carcinoma (NEC), or adenocarcinoma (ADK). These cancers are treated differently, and doctors continue to study which approaches work best.

A new study used data from over 800 patients with stage T2N0M0 non-urothelial bladder cancers, meaning the cancer was confined to the bladder wall and had not spread to lymph nodes or other organs. Researchers compared two treatments:

Trimodal therapy (TMT): a bladder-sparing approach combining surgery to remove the tumor, chemotherapy, and radiation.
Radical cystectomy (RC): surgery to remove the entire bladder.

The results showed that overall, patients who had their bladder removed lived longer and had lower cancer-specific death rates than those who received trimodal therapy. After 5 years, about 29% of patients who had surgery died from cancer compared with 50% of patients who had trimodal therapy.

The difference was most striking in patients with squamous cell carcinoma and neuroendocrine carcinoma. In these groups, surgery clearly worked better than trimodal therapy. In patients with adenocarcinoma or other rare types, survival was more similar between the two treatments.

These findings suggest that surgery may give the best chance of long-term survival for many patients with rare bladder cancers, especially squamous cell and neuroendocrine types. For some subtypes, like adenocarcinoma, both approaches may work similarly, and decisions can be more personalized.

Patients facing treatment choices for these uncommon bladder cancers should have detailed discussions with their doctors about whether bladder removal surgery or a bladder-sparing approach is more appropriate for their specific cancer type.

DOI: 10.1002/jso.70014

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