Treatment Selection and Survival In Muscle‐Invasive Bladder Cancer: Real‐World Data on the Impact of Geriatric‐8 Screening

AIM: Standard treatment for muscle-invasive bladder cancer (MIBC) includes radical cystectomy (RC), a highly invasive procedure. We evaluated the utility of the Geriatric-8 (G8) screening tool in guiding treatment and whether the survival benefit of RC differs by G8 score. METHODS: We retrospectively reviewed patients with non-metastatic MIBC who underwent G8 assessment (2020-2024). Patients were grouped by G8: low (<11), intermediate (11-14), and high (>14). Treatment patterns and the effectiveness of RC were evaluated. RESULTS: A total of 152 patients were included (high: n = 55, intermediate: n = 67, low: n = 30). RC was performed in 124 patients (81.6%). Lower G8 was linked to older age, poorer performance status, and dependent instrumental activities of daily living (p < 0.01). Neoadjuvant chemotherapy followed by RC was more frequently planned in the high G8 group (81.8% vs. 53.7% vs. 26.7%, p < 0.0001), while immediate RC was a more common plan in the low G8 group (14.5% vs. 41.8% vs. 53.3%, p = 0.0003). RC was associated with significantly improved overall survival, and the benefit persisted after propensity score matching (p = 0.0013). Inverse probability of treatment weighting, which retained the whole cohort, gave a consistent estimate (hazard ratio [HR] 0.17, 95% confidence interval [CI] 0.08-0.39). Subgroup estimates were less precise in the low G8 group (HR 0.57, 95% CI 0.12-2.73) than in the intermediate (HR 0.14, 95% CI 0.06-0.33) and high (HR 0.10, 95% CI 0.02-0.39) groups. In sliding window analysis, HR estimates were higher at G8 < 9, with wide CIs. Similar results were observed for cancer-specific survival. CONCLUSIONS: RC was associated with a survival benefit in patients with intermediate and high G8 scores, whereas the evidence in the low G8 group was limited and inconclusive; careful risk-benefit evaluation remains warranted in this group.