Treatment Patterns and Outcomes in Localized Urothelial Carcinoma in Middle-Income Countries: A Multicenter Real-World Study.

Abstract

Disparities in health care access and resource availability in middle-income countries often lead to suboptimal management of localized bladder urothelial carcinoma (UC). However, real-world data describing treatment patterns and outcomes in these settings remain limited. This multicenter, retrospective, real-world study included patients with high-risk non-muscle-invasive (HR-NMIBC) and localized muscle-invasive bladder cancer (MIBC) diagnosed between 2017 and 2022 across nine cancer centers in a middle-income setting. Treatment data and clinical outcomes were collected from medical records and analyzed using descriptive statistics and Kaplan-Meier survival estimates. Among 343 patients analyzed, 217 (63.3%) had HR-NMIBC, of whom only 29.5% received adjuvant Bacillus Calmette-Guérin (BCG), often substituted with intravesical gemcitabine because of supply shortages. BCG exposure was associated with superior overall and cancer-specific survival compared with non-BCG patients. In the muscle-invasive cohort (n = 126; 36.7%), cystectomy was performed in 48.4% and significantly improved survival. Perioperative chemotherapy remained limited, with only 39.3% receiving neoadjuvant therapy, and just one third receiving cisplatin-based regimens that conferred the greatest survival benefit. This multicenter real-world study exposes major gaps in the management of localized UC in a middle-income setting. Limited access to BCG, perioperative chemotherapy, and cystectomy remain key barriers to guideline-concordant care, underscoring the urgent need for policy actions to improve treatment delivery and outcomes in comparable health care systems.