Neoadjuvant therapy plus thulium laser transurethral bladder tumor resection for muscle-invasive bladder cancer.

Background: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). However, its high perioperative mortality and significant impact on quality of life have led many patients to opt for bladder-preserving approaches, which currently lack a standardized treatment protocol. Objective: This study evaluated the efficacy and feasibility of bladder-preserving therapy using thulium laser maximal transurethral resection of bladder tumors (TURBT) combined with neoadjuvant therapy and immunotherapy in MIBC patients. Methods: A retrospective analysis was conducted on 46 MIBC patients treated with neoadjuvant therapy followed by thulium laser maximal TURBT at a single center between January 2021 and October 2024. Patients had received neoadjuvant immunotherapy in combination with chemotherapy or antibody-drug conjugate before maximal thulium laser TURBT. Those who achieved a complete clinical response were allowed to pursue either bladder preservation or RC. Patients choosing bladder-preserving therapy were either given maintenance immunotherapy or put on observation. Bladder-intact disease-free survival (BIDFS) was assessed through Kaplan-Meier analysis, and Cox regression identified factors influencing BIDFS. Results: Among the 46 patients, 95.7% remained alive, and 82.6% demonstrated no evidence of cancer with bladder function preserved. The estimated 2-year BIDFS rate was 84.2%, and T stage and maintenance immunotherapy were identified as two independent predictors of BIDFS. Patients receiving immunotherapy were at a significantly reduced risk of recurrence compared to their counterparts under observation. Conclusion: Thulium laser maximal TURBT, combined with neoadjuvant therapy and maintenance immunotherapy, is a promising bladder-preserving approach that helps MIBC patients attain favorable BIDFS and quality of life.