Contemporary Trends in the Surgical and Systemic Management of Muscle-Invasive Bladder Cancer: Insights From a Nationwide Multicenter Cohort in Turkey Over 2 Decades

Abstract

Introduction: To evaluate two-decade temporal trends in the surgical and systemic management of muscle-invasive bladder cancer (MIBC) in Turkey and to characterize demographic, clinical, and therapeutic patterns in a nationwide multicenter cohort. Patients and Methods: This multicenter retrospective cohort study included patients who underwent radical cystectomy (RC) for MIBC between 2001 and 2025 across 27 tertiary centers in Turkey. Demographic, clinical, pathological, and treatment-related data were collected using a standardized electronic case report form. Patients with metastatic disease, incomplete data, or palliative cystectomy were excluded. Temporal trends in neoadjuvant chemotherapy (NAC), surgical approach, and urinary diversion were analyzed using the Cochran-Armitage trend test. Results: A total of 2,371 patients were included (85.8% male; median age, 66 years). Urothelial carcinoma was the predominant histology, with variant histology observed in 5.2% of cases. NAC was administered to 12.1% of patients and increased significantly over time (p = 0.033). Orthotopic neobladder use decreased significantly (p < 0.001), remaining below 15% overall despite a transient increase between 2008 and 2010. Surgical approaches changed significantly over time (p < 0.001), with increasing adoption of minimally invasive techniques, although open RC remained predominant (83.0%). Pathologically, 46.3% had >= pT3 disease and 24.8% had lymph node metastasis. Conclusions: Despite increasing adoption of NAC and minimally invasive surgery, important gaps remain in the implementation of perioperative systemic therapy and continent urinary diversion. These findings demonstrate persistent discrepancies between real-world practice and guideline recommendations and support efforts to strengthen multidisciplinary care and improve access to evidence-based perioperative treatment.