ECOG ACRIN EA8192 cohort C: a phase 2 trial of neoadjuvant gemcitabine/durvalumab in patients with high grade upper tract urothelial carcinoma (UTUC) ineligible for cisplatin-based chemotherapy. In this multicenter trial, researchers evaluated the efficacy and safety of neoadjuvant gemcitabine and durvalumab in cisplatin-ineligible patients with high-grade upper tract urothelial carcinoma (UTUC). Thirty-one patients enrolled in the trial from 2022 to 2025; median age was 79 years, and 19 patients were men. Fifteen patients each had renal pelvis and ureteral tumors, and 1 patient had a multifocal tumor. Thirty patients received at least 1 dose of gemcitabine and durvalumab, and 23 completed the 4 planned cycles. Pathologic complete response (pCR) occurred in 3 patients (10%; 90% confidence interval [CI]: 3.0–25.2%), and pathologic stage <ypT2N0/x was achieved by 10 patients (33%; 90% CI: 19.3–49.9%). Treatment-related adverse events (TRAEs) were reported in 30 patients, 13 of whom experienced grade 3 to 4 TRAEs, most commonly anemia (n=4) and neutropenia (n=4). Five treated patients did not undergo nephroureterectomy (NU), and 6 patients did not undergo lymph node dissection. Among patients who received NU, median time from last neoadjuvant dose to NU was 10 weeks (range: 5–22 weeks). Estimated 1-year event-free survival (EFS) was 77.4% at median 11-month follow-up. These findings indicate the feasibility and safety of neoadjuvant gemcitabine and durvalumab in patients with high-grade UTUC.
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Survival outcomes in metastatic bladder cancer patients in the United States. Researchers assessed data from the Surveillance, Epidemiology, and End Results (SEER) database to identify trends in survival outcomes among patients with metastatic bladder cancer. A total of 6,601 patients diagnosed from 2010 to 2021 were included for analysis. Mean age was 69 years, and 70% of patients were male. The majority of patients had transitional cell carcinoma (82%) and had undergone prior bladder surgery (78%). Forty-six percent of patients had liver or lung metastases. In the overall cohort, median cancer-specific survival (CSS) and overall survival (OS) were 8 and 7 months, respectively; 5-year CSS rate was 10%, and 5-year OS rate was 7%. Median CSS and OS were both 9 months in 2,306 patients aged <65 years, and 5-year CSS and OS rates were 11% and 9%, respectively. Among 4,295 patients aged ≥65 years, median CSS and OS were shorter, at 7 and 6 months, respectively, and 5-year CSS and OS rates were 10% and 7%, respectively. Outcomes improved with diagnosis in later years; 5-year relative survival was 6% in patients diagnosed in 2010 (n=473), increasing to 9% for those diagnosed in 2015 (n=584) and 12% for those diagnosed in 2021 (n=653). Significant predictors of CSS and OS included age, sex, race, histology, and lack of prior bladder surgery (all P<0.05).
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The overlooked culprit: tumor size in muscle-invasive bladder cancer. In this study, researchers assessed the potential relationship between tumor size and outcomes following radical cystectomy for muscle invasive bladder cancer (MIBC). A total of 1,168 patients were included for analysis, and they were classified into 4 quartiles based on final pathological size. In quartiles 1 to 4 (Q1–4), median tumor sizes were 1.2 cm, 2.5 cm, 3.8 cm, and 6.0 cm, respectively. Patients with larger tumors had a greater likelihood of having extravesical or lymph node–positive disease, variant histology, and lymphovascular invasion. The 30- and 90-day complication rates were similar across quartiles (P=0.479 and 0.785, respectively), as were 30- and 90-day readmissions rates and 90-day complication subtypes. According to multivariable analysis, when adjusting for confounders, Q3 and Q4 exhibited significantly higher risk of recurrence (Q3: HR: 1.5; 95% CI: 1.1–2.0; P=0.005; Q4: HR: 2.1; 95% CI: 1.5–2.7; P<0.001) and death (Q3: HR: 1.4; 95% CI: 1.1–1.8, P=0.011; Q4: HR: 2.2; 95% CI: 1.7–2.8, P<0.001) compared to Q1. These findings suggest that tumor size might be a meaningful prognostic factor in MIBC.
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Association of non-luminal subtype with overall survival in high-risk non-muscle invasive bladder cancer patients: Biomarker results from the Bladder Cancer Prognosis Programme. In this study, researchers compared outcomes of high-risk non-MIBC (NMIBC) based on molecular subtype. Genomic subtyping was performed on transurethral resection of bladder tumor (TURBT) specimens from patients in the Bladder Cancer Prognosis Programme registry. In total, 259 patients were included for analysis, 192 (74%) with stage T1 disease and 67 (26%) with stage Ta disease. Eighty-three patients (32%) died. Median follow-up was 5.2 years. Forty patients had nonluminal subtype, and 219 had luminal subtype. Stage cT1 disease was significantly more prevalent in the nonluminal tumor group compared to the luminal tumor group (P=0.007). In the nonluminal tumor group, 55% of patients (n=22) died, compared to 28% (n=61) in the luminal tumor group; estimated 5-year OS was 44% vs 72%, respectively. There was a significant association between molecular tumor subtype and OS, according to multivariable analysis (hazard ratio [HR]: 1.91; 95% CI: 1.16–3.15; P=0.01). Among 56 patients with very high–risk NMIBC, as per the 2025 European Association of Urology guidelines, multivariable analysis also showed a significant association between nonluminal subtype and OS (HR: 2.55; 95% CI: 1.08–6.00; P=0.03).
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Real-world neoadjuvant therapy utilization and outcomes in patients with muscle-invasive bladder cancer ineligible for cisplatin treatment. Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for MIBC, but many patients are cisplatin-ineligible. In this retrospective study, researchers analyzed data from the Flatiron Health Research Database to examine NAC utilization and outcomes among cisplatin-ineligible patients with MIBC. Patients diagnosed in 2015 or later who underwent primary surgery were included for analysis. Among 5,016 patients, 10.2% were cisplatin-ineligible, 26.9% were cisplatin-eligible, and 62.9% had indeterminate status. The cisplatin-ineligible group had shorter median (95% CI) real-world OS (rwOS) and real-world disease-free survival (rwDFS), at 39.9 (30.9–48.2) and 17.0 (13.7–23.0) months, respectively, compared to the cisplatin-eligible group (74.7 [69.6–86.6] and 59.7 [52.3–63.8] months, respectively). In the cisplatin-ineligible group, 45.2% received cisplatin-based NAC and 32.9% did not receive NAC; the former tended to have more favorable features, such as younger age and higher baseline creatinine clearance. In cisplatin-ineligible patients treated with cisplatin-based NAC vs those with no NAC, median (95% CI) rwOS was 48.2 (30.9–67.6) vs 29.6 (20.4–46.1) months, and median (95% CI) rwDFS was 21.1 (14.3–34.2) vs 15.0 (11.7–21.3) months. Adjusted Cox analysis showed that receipt of cisplatin-based NAC was associated with improved OS (HR: 0.75; 95% CI: 0.55–1.04) but not DFS (HR: 1.00; 95% CI: 0.73–1.37) compared to no NAC in cisplatin-ineligible patients with MIBC.
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Inpatient outcomes of bladder cancer: racial and socioeconomic disparities in a nationally representative sample (2020-2022). Here, researchers analyzed National Inpatient Sample 2020 to 2022 data to determine the impact of race and sociodemographic factors on hospitalization outcomes among patients with bladder cancer. Among 257,710 inpatients, 79.5% were White, 8.1% were Black, 5.7% were Hispanic, and 6.7% were other. A greater proportion of Black (31.8%) and Hispanic (26.6%) patients were younger than 65 years of age, compared to White patients (17.2%). Twenty-two percent of White patients were in the lowest income quartile, compared to 35.0% of Hispanic patients and 47.9% of Black patients. A total of 14.2% of Black patients and 13.9% of Hispanic patients had Medicaid, compared to 4.1% of White patients. The crude in-hospital mortality rate was 5.0%, and adjusted analyses showed that Black patients had a significantly higher likelihood of in-hospital mortality (odds ratio [OR]: 1.31; P<0.05) and nonhome discharge (OR: 1.14; P<0.05) compared to White patients. Additionally, Black and Hispanic patients had significantly longer length of stay when compared to White patients (+0.8 and +0.5 days, respectively; both P<0.05). Compared to White patients, adjusted charges were higher for Hispanic (+$15,070), and Other (+$6,567), and Black (+$4,683; all P<0.05) patients.
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