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

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.