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Journals / Turkish Journal of Clinics and Laboratory / 2026 / Cilt: 16 Sayı: 3

Bladder-sparing trimodal therapy in elderly patients with muscle-invasive bladder cancer: a real-world single-center experience

Yaşlı kas invaziv mesane kanseri hastalarında mesane koruyucu trimodal tedavi: tek merkez gerçek yaşam deneyimi

Volkan Aslan(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0001-5685-3748
Hüseyin Atacan(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0002-1472-6924
Aybala Nur Ucgul(Department of Radiation Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0001-8373-113X
Gül Sema Keskin(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0001-6858-6974
İsa Dede(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0002-1836-9370
Doğan Bayram(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0002-5976-2494
Musa Barış Aykan(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0001-7538-9119
İsmail Ertürk(Department of Radiation Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0001-6835-0988
Nuri Karadurmuş(Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Türkiye)0000-0003-3291-8062
Pages
465–472
Publication Date
2025-09-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and the impact of clinical and laboratory variables on survival was assessed through multivariable Cox regression analysis.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: This study aimed to evaluate survival outcomes and potential prognostic indicators in a real-world cohort of elderly patients diagnosed with early-stage muscle-invasive bladder cancer (MIBC) who underwent trimodal therapy (TMT).
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Key Findings & Data:Material and Methods: This retrospective study included 23 patients with a mean age of 70 years diagnosed with stage T2N0–T2N1 MIBC and treated with TMT, which comprised maximal transurethral resection, chemotherapy, and radiotherapy.
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Conclusion & Impact:Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and the impact of clinical and laboratory variables on survival was assessed through multivariable Cox regression analysis.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:kas invaziv mesane tümörü · trimodal tedavi · yaşlı hasta

Abstract

Aim: This study aimed to evaluate survival outcomes and potential prognostic indicators in a real-world cohort of elderly patients diagnosed with early-stage muscle-invasive bladder cancer (MIBC) who underwent trimodal therapy (TMT). Material and Methods: This retrospective study included 23 patients with a mean age of 70 years diagnosed with stage T2N0–T2N1 MIBC and treated with TMT, which comprised maximal transurethral resection, chemotherapy, and radiotherapy. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and the impact of clinical and laboratory variables on survival was assessed through multivariable Cox regression analysis. Inflammatory biomarkers such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were also evaluated for their prognostic significance. Results: The median OS was 22 months (95% CI: 12.5–31.5), and the median PFS was 19 months (95% CI: 14.5–47.4). Patients receiving platinum-based chemotherapy had significantly improved OS (HR: 0.041; p = 0.015). Higher platelet-to-lymphocyte ratio (PLR) and advanced nodal stage (N stage) were negatively associated with OS. Although no factor was significantly associated with PFS, a trend toward decreased survival was observed with increasing T stage. Radiotherapy dose did not have a significant impact on survival outcomes. Conclusion: This study highlights the efficacy and tolerability of TMT in elderly, comorbid patients with early-stage MIBC who are candidates for bladder preservation. Platinum-based regimens appear to confer a survival advantage, while PLR and nodal stage may serve as practical prognostic markers. Given the acceptable survival outcomes and favorable toxicity profile, TMT should be considered a promising bladder-sparing option for appropriately selected elderly patients.

Özet

Amaç: Bu çalışmada, erken evre kas invaziv mesane kanseri (MIBC) tanısı almış ve trimodal tedavi (TMT) uygulanmış ileri yaşlı hasta grubunda, gerçek yaşam verileri kullanılarak sağkalım sonuçları ile prognostik belirteçlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif analizde, yaş ortalaması 70 olan ve evre T2N0–T2N1 MIBC tanısı alarak TMT (maksimal transüretral rezeksiyon, kemoterapi ve radyoterapi) uygulanmış 23 hasta değerlendirilmiştir. Genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) Kaplan-Meier yöntemiyle hesaplanmış; prognostik faktörler çok değişkenli Cox regresyon analiziyle incelenmiştir. Ayrıca, PLR ve NLR gibi sistemik inflamatuar belirteçlerin prognostik rolü de değerlendirilmiştir. Bulgular: Ortanca OS süresi 22 ay (%95 GA: 12,5–31,5), ortanca PFS süresi ise 19 ay (%95 GA: 14,5–47,4) olarak hesaplanmıştır. Platin bazlı kemoterapi uygulanan hastalarda OS anlamlı şekilde daha uzun bulunmuştur (HR: 0,041; p = 0,015). Yüksek PLR ve ileri N evresi OS ile negatif yönde ilişkili bulunmuştur. PFS açısından anlamlı bir değişken saptanmamış olmakla birlikte, T evresindeki artış sağkalımda azalma eğilimi göstermiştir. Radyoterapi dozunun sağkalım üzerinde anlamlı bir etkisi gözlenmemiştir. Sonuç: Bu çalışma, komorbiditesi yüksek yaşlı MIBC hastalarında TMT’nin etkin ve tolere edilebilir bir tedavi seçeneği olduğunu göstermektedir. Platin temelli rejimlerin sağkalım avantajı sağladığı; PLR ve nodal evrenin ise potansiyel prognostik belirteçler olarak öne çıktığı belirlenmiştir. Kabul edilebilir toksisite oranları ve sağkalım verileri göz önünde bulundurulduğunda, TMT yaşlı bireyler için mesane koruyucu umut verici bir alternatif olarak değerlendirilmelidir.

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Cite This Article

Aslan, V., Atacan, H., Ucgul, A. N., Keskin, G. S., Dede, İ., Bayram, D., Aykan, M. B., Ertürk, İ., Karadurmuş, N. (2025). Bladder-sparing trimodal therapy in elderly patients with muscle-invasive bladder cancer: a real-world single-center experience. Turkish Journal of Clinics and Laboratory, Cilt: 16 Sayı: 3, 465–472. https://doi.org/10.18663/tjcl.1738115

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