Real-World Outcomes After Radical Cystectomy for Muscle-Invasive Bladder Cancer in Japan: A Nationwide Descriptive Study From the National Clinical Database.

OBJECTIVE

To describe real-world disease-free survival (DFS) and overall survival (OS) after radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) in Japan using nationwide data from the National Clinical Database (NCD).

METHODS

This nationwide descriptive study included patients with MIBC who underwent RC and were registered in the NCD in 2020. Demographic and clinical characteristics, including age, sex, surgical approach, neoadjuvant chemotherapy (NAC), and pathological stage, were summarized. DFS and OS were estimated using the Kaplan-Meier method. Survival outcomes were descriptively compared across age groups, sex, NAC status, and surgical approach without adjustment for baseline characteristics.

RESULTS

A total of 3773 patients were analyzed. The cohort showed an advanced age distribution, with 41% aged ≥ 75 years. Robotic-assisted RC was the most frequently performed approach (44%), and NAC was administered in 52% of patients. Survival declined progressively with increasing age, with the poorest outcomes observed in patients aged ≥ 80 years. Female sex and nonreceipt of NAC were associated with modestly lower DFS and OS in unadjusted analyses. Robotic-assisted and laparoscopic RC demonstrated comparable DFS and OS, whereas open RC was associated with less favorable survival outcomes.

CONCLUSIONS

This nationwide descriptive analysis provides a comprehensive snapshot of real-world survival after RC for MIBC in Japan. This nationwide data reveal marked heterogeneity in patient characteristics, treatment patterns, and outcomes, and provide a foundation for identifying clinically relevant hypotheses for future risk-adjusted analyses.