ArticleAdvances in therapy2026
Treatment Pathway and Clinical Outcomes of the Population with Muscle-invasive Bladder Cancer in Italy: A Real-world Analysis with Administrative Databases.
Article in Advances in therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn Italy, real-world data on muscle-invasive bladder cancer (MIBC) are scanty. This analysis exploited administrative databases to describe the clinical characteristics and treatment outcomes of patients with MIBC.
methodsAdults hospitalized for non-metastatic bladder cancer who underwent cystectomy in 2018 were proxied for MIBC. The following variables were examined: demographic and clinical characteristics, number of transurethral resections of the bladder tumor (TURBs) and time to cystectomy to discriminate de novo diagnoses from progressions; chemotherapy ± 6 months before/after cystectomy to distinguish neoadjuvant or adjuvant regimens; creatinine clearance (CrCl) as an indicator of renal function for cisplatin eligibility; disease-free survival (DFS) and overall survival (OS) using Kaplan-Meier method.
resultsAmong 394 patients included, 79.4% were men; mean age was 72.5 years and Charlson comorbidity index (CCI) 0.6. Three hundred thirty-nine (86%) had ≥ 1 TURBs pre-cystectomy: 222 (56%) were de novo diagnoses and 117 (30%) progressions from non-muscle-invasive disease. After stratification by CrCl (< 40, 40-60, and ≥ 60 ml/min), patients with lower renal function showed older age (76.8, 77.0, and 69.1 years), worse comorbidity profile (CCI: 1.5, 0.7, and 0.6), and markedly higher mortality rates (95.0%, 92.9%, and 42.3%). One hundred ninety-five patients (49.5%) underwent surgery-only, 199 (50.5%) received chemotherapy: 47 (12%) as neoadjuvant, 132 (33.5%) as adjuvant, and 20 (5%) as perioperative treatment. Median DFS was 0.9 years with a time to progression of 2.1 years; median OS was 2.1 years with a 5-year OS rate of 43%.
conclusionsFrom this real-world analysis, Italian patients with MIBC emerged as a population of elderly subjects (> 75 years) burdened by comorbidities. Treatment choice was influenced by other factors rather than cisplatin eligibility since only 11% of patients with CrCl ≥ 60 ml/min in 2018 and 20% in 2022 were treated before cystectomy, highlighting a scenario of low adherence to guidelines with underutilization of neoadjuvant chemotherapy.
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