Impact of COVID-19 care reorganization on the prognosis of patients with bladder urothelial carcinoma: a multicentric retrospective study.

BACKGROUND

The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delayed cancer diagnosis and treatment. In France, transurethral resection of bladder tumors (TURBT) was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma. This study aimed to assess the impact of care reorganization on tumor staging, recurrence, palliative care, and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.

METHODS

We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019 (pre-pandemic), 2020 (early pandemic), 2021 (mid-pandemic), and 2022 (late pandemic) in two French institutions. TURBT indications were categorized as diagnostic, palliative, or staging. Clinical and pathological data were compared across the four periods. Statistical analyses included Chi-square tests, Estimated Annual Percentage Change (EAPC), and multivariable logistic regression adjusted for age, sex, ASA score, and center.

RESULTS

A total of 790 TURBT procedures were analyzed. The proportion of muscle-invasive bladder cancer (pT ≥ 2) declined over time (18.7% in 2019 to 13.2% in 2022; p = 0.63), while superficial tumors (pTa) increased (57.2% to 65.5%). All-cause mortality significantly decreased from 38.0% in 2019 to 22.0% in 2020, 20.5% in 2021, and 19.5% in 2022 (p = 0.006). EAPC showed a significant annual decline in mortality (-24.3%, p = 0.004). In multivariable analysis, 2020, 2021, and 2022 were each associated with significantly lower odds of mortality compared to 2019. Recurrence rates remained stable across all periods (p = 0.93). Inter-hospital variation persisted in mortality and recurrence.

CONCLUSIONS

Despite the pandemic, urothelial bladder cancer outcomes did not worsen through 2022. On the contrary, timely reorganization, prioritization of TURBT, and triage strategies were associated with reduced mortality and palliative care needs, highlighting the resilience of cancer care when guided by adaptive health policies.