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Cytoreductive cystectomy combined with chemotherapy versus chemotherapy alone in the treatment of metastatic bladder cancer: A retrospective comparative study

Year: 2026

Type: article

Abstract: Introduction: The role of cytoreductive surgery in metastatic bladder cancer remains controversial. While systemic chemotherapy is the standard of care, the potential benefit of combining chemotherapy with radical cystectomy in selected patients requires further evaluation. Material and methods: We performed a retrospective cohort study of 192 patients with metastatic urothelial carcinoma treated between 2008 and 2022. Patients were divided into two groups: treatment with four cycles of gemcitabine-cisplatin followed by cytoreductive cystectomy in selected non-progressing patients (n = 90), and treatment with chemotherapy alone (n = 102). Median follow-up was 14.2 months. Cancer-specific survival (CSS) was evaluated using Kaplan-Meier analysis and Cox regression with adjustment for baseline characteristics. Results: Median CSS was longer in the cystectomy group compared to chemotherapy alone (19.6 vs 12.6 months, p = 0.03). Treatment-related toxicity was comparable between groups. Cytoreductive cystectomy also provided symptomatic relief in patients with local complications such as hematuria, pain, and urinary obstruction. Conclusions: Cytoreductive cystectomy combined with systemic chemotherapy may be associated with improved survival in carefully selected patients with metastatic urothelial carcinoma. These findings should be interpreted with caution due to the retrospective design and potential selection bias.

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DOI: 10.5173/ceju.2025.0278