Meta-analysis compares bladder preservation therapy vs cystectomy in elderly muscle-invasive bladder cancer

BACKGROUND: The oncological safety of bladder preservation therapy (BPT) versus standard radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC) remains controversial. MATERIALS AND METHODS: Adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, we conducted a systematic literature review of publications indexed in the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases through July 2025. This meta-analysis evaluated the oncological safety of BPT compared with that of RC for the treatment of elderly patients with MIBC. The outcomes were overall survival (OS) rates at 1, 5, and 10 years; cancer-specific survival (CSS) rates at 1 and 5 years; and mortality rates. RESULTS: Our analysis included 8 studies with a total of 4888 patients, comprising 2534 patients undergoing BPT and 2354 undergoing RC. BPT and RC did not differ significantly in 1-year OS (odds ratio [OR]) 0.81; 95% confidence interval [CI] 0.46, 1.41; p = 0.45), 5-year OS (OR 0.83; 95% CI 0.51, 1.36; p = 0.46), 10-year OS (OR 1.09; 95% CI 0.24, 4.89; p = 0.91), and 1-year CSS (OR 0.80; 95% CI 0.61, 1.04; p = 0.10). However, BPT was inferior in terms of 5-year CSS (OR 0.51; 95% CI 0.42, 0.63; p < 0.00001) and exhibited a higher mortality rate (OR 2.06; 95% CI 1.24, 3.42; p = 0.005). CONCLUSIONS: BPT was proven more favorable for elderly patients when contrasted with those of unstratified age groups. Indirect comparisons within BPT sub-analyses suggest that combining transurethral resection of bladder tumors (TURBT) with chemoradiotherapy (CRT) might yield greater benefits than either treatment alone or in dual combination. Due to high heterogeneity and the retrospective design of included studies, the results should be interpreted with caution.