Treatment Patterns and Long-Term Survival Outcomes in Muscle-Invasive Bladder Cancer: A Decade-Long Single-Institution Retrospective Cohort Study.

INTRODUCTION: Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy with heterogeneous treatment approaches and outcomes. Long-term survival data from real-world settings remain limited. We evaluated treatment patterns and 10-year survival outcomes in a large single-institution cohort of patients with MIBC. MATERIALS AND METHODS: This retrospective cohort study included 349 patients with MIBC who were treated at Shaukat Khanum Cancer Hospital and Research Centre, Pakistan between 2010 and 2020. Treatment strategies comprised neoadjuvant chemotherapy followed by radical cystectomy or definitive chemoradiotherapy or radiotherapy, upfront cystectomy, definitive bladder-preserving chemoradiotherapy, radiotherapy alone, and palliative treatment. Overall survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors. RESULTS: The median age was 57 years, with male predominance of 82.2%. High-grade disease was present in 88.5% of patients. At last follow-up, 67.9% of patients were alive. Overall survival differed significantly across treatment strategies (log-rank p < 0.001). Median overall survival was not reached in curative-intent treatment groups, whereas patients treated with palliative intent had an inferior median overall survival of 30 months. In multivariate analysis, Stage IV disease (adjusted HR 2.41, 95% CI 1.33 to 4.37) and palliative treatment (adjusted HR 3.30, 95% CI 1.49 to 7.31) were independently associated with worse survival. After adjustment, no statistically significant differences in overall survival were observed between definitive surgical and bladder preserving approaches, noting the limitations of non-randomized treatment allocation. CONCLUSION: Definitive treatment was associated with durable long-term survival in appropriately selected patients. Disease stage and treatment intent remained the dominant determinants of outcome. Bladder-preserving chemoradiotherapy was an effective definitive option in selected patients in this real-world cohort.