Research Article

Comparative Outcomes of Surgery and Chemoradiotherapy After Neoadjuvant Chemotherapy in Stage II–III Bladder Cancer

Volume: 12 Number: 2 February 1, 2026
The European Research Journal Cover
The European Research Journal
PDF Download

Comparative Outcomes of Surgery and Chemoradiotherapy After Neoadjuvant Chemotherapy in Stage II–III Bladder Cancer

Abstract

Objectives: Radical cystectomy following neoadjuvant chemotherapy is the standard treatment for Muscle-Invasive Bladder Cancer (MIBC). However, definitive chemoradiotherapy may represent a viable alternative in patients who are medically inoperable or decline surgery. This study aimed to compare the clinical outcomes of patients with stage II–III MIBC treated with neoadjuvant chemotherapy followed by either Radical cystectomy or CRT, the latter performed without maximal transurethral resection of bladder tumor (TURBT).

Methods: This retrospective study included 63 patients with stage II–III MIBC treated between December 2014 and March 2025 at two tertiary referral centers in Türkiye. All patients received neoadjuvant chemotherapy (NAC) prior to either surgery (n=39) or Chemoradiotherapy (CRT) (n=24). Clinicopathological, laboratory, and survival data were analyzed. Overall Survival (OS) and Event-Free Survival (EFS) were assessed using the Kaplan–Meier method and compared with the log-rank test. Cox regression was used to identify independent prognostic factors.

Results: The median age was 64 years, and 88.9% of patients were male. Comorbidities were more frequent in the CRT group (79.2% vs. 59%), though the difference was not statistically significant (P=0.099). Median OS was 46.5 months in the surgery group and 31.6 months in the CRT group (P=0.407), while median EFS was 30.1 and 21.0 months, respectively (P=0.375). Distant metastasis was the most common recurrence pattern (36.5%). Multivariate analysis identified comorbidity (Hazard ratio [HR] = 0.37, 95% CI: 0.17–0.80, P=0.012) and hemoglobin <12 g/dL (HR =0.53, 95% CI: 0.25–0.94, P=0.048) as independent predictors of poor survival.

Conclusions: NAC followed by either surgery or CRT provides comparable long-term disease control in patients with stage II–III MIBC. Although RC remains the gold standard for operable patients, CRT offers an effective curative-intent option for those unfit for surgery—even in the absence of maximal TURBT. Comorbidity and anemia were significant adverse prognostic factors, emphasizing the importance of individualized treatment selection in this patient population.

Keywords

Ethical Statement

This study was approved by the Ankara Bilkent City Hospital Clinical Research Ethics Committee No. 1 (Decision No: E1-23-4506; date: 27.12.2023). Additionally, the study’s ethics approval was re-obtained on a multicenter basis: approval granted by Ankara City Hospital Ethics Committee (Date: July 30, 2025/Approval No: E1-25-1550). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data.

References

  1. 1. Cho SW, Lim SH, Kwon GY, et al. Neoadjuvant Cisplatin-Based Chemotherapy Followed by Selective Bladder Preservation Chemoradiotherapy in Muscle-Invasive Urothelial Carcinoma of the Bladder: Post Hoc Analysis of Two Prospective Studies. Cancer Res Treat. 2024;56(3):893-897. doi: 10.4143/crt.2024.015.
  2. 2. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45. doi: 10.3322/caac.21871.
  3. 3. Dyrskjøt L, Hansel DE, Efstathiou JA, et al. Bladder cancer. Nat Rev Dis Primers. 2023;9(1):58. doi: 10.1038/s41572-023-00468-9.
  4. 4. Netto GJ, Amin MB, Berney DM, et al. The 2022 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs-Part B: Prostate and Urinary Tract Tumors. Eur Urol. 2022;82(5):469-482. doi: 10.1016/j.eururo.2022.07.002.
  5. 5. Paner GP, Stadler WM, Hansel DE, Montironi R, Lin DW, Amin MB. Updates in the Eighth Edition of the Tumor-Node-Metastasis Staging Classification for Urologic Cancers. Eur Urol. 2018;73(4):560-569. doi: 10.1016/j.eururo.2017.12.018.
  6. 6. Peyton CC, Tang D, Reich RR, et al. Downstaging and Survival Outcomes Associated With Neoadjuvant Chemotherapy Regimens Among Patients Treated With Cystectomy for Muscle-Invasive Bladder Cancer. JAMA Oncol. 2018;4(11):1535-1542. doi: 10.1001/jamaoncol.2018.3542.
  7. 7. Fahmy O, Khairul-Asri MG, Schubert T, et al. A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol. 2018;36(2):43-53. doi: 10.1016/j.urolonc.2017.10.002.
  8. 8. Witjes JA, Babjuk M, Bellmunt J, et al. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort†: Under the Auspices of the EAU-ESMO Guidelines Committees. Eur Urol. 2020;77(2):223-250. doi: 10.1016/j.eururo.2019.09.035.

Details

Primary Language

English

Subjects

Cancer Diagnosis , Cancer Therapy (Excl. Chemotherapy and Radiation Therapy)

Journal Section

Research Article

Authors

Early Pub Date

December 18, 2025

Publication Date

February 1, 2026

Submission Date

October 20, 2025

Acceptance Date

November 20, 2025

Published in Issue

Year 2026 Volume: 12 Number: 2

DOI

https://doi.org/10.18621/eurj.1807684

IZ

https://izlik.org/JA85CP34NL

Cite

RIS / Bibtex
AMA
1.Bayram D, Bal Ö, Türkel A, et al. Comparative Outcomes of Surgery and Chemoradiotherapy After Neoadjuvant Chemotherapy in Stage II–III Bladder Cancer. Eur Res J. 2026;12(2):160-172. doi:10.18621/eurj.1807684