Treatment Selection and Survival In Muscle‐Invasive Bladder Cancer: Real‐World Data on the Impact of Geriatric‐8 Screening

Abstract

ABSTRACT Aim Standard treatment for muscle‐invasive bladder cancer (MIBC) includes radical cystectomy (RC), a highly invasive procedure. We evaluated the utility of the Geriatric‐8 (G8) screening tool in guiding treatment and whether the survival benefit of RC differs by G8 score. Methods We retrospectively reviewed patients with non‐metastatic MIBC who underwent G8 assessment (2020–2024). Patients were grouped by G8: low (<11), intermediate (11–14), and high (>14). Treatment patterns and the effectiveness of RC were evaluated. Results A total of 152 patients were included (high: n = 55, intermediate: n = 67, low: n = 30). RC was performed in 124 patients (81.6%). Lower G8 was linked to older age, poorer performance status, and dependent instrumental activities of daily living ( p < 0.01). Neoadjuvant chemotherapy followed by RC was more frequently planned in the high G8 group (81.8% vs. 53.7% vs. 26.7%, p < 0.0001), while immediate RC was a more common plan in the low G8 group (14.5% vs. 41.8% vs. 53.3%, p = 0.0003). RC was associated with significantly improved overall survival, and the benefit persisted after propensity score matching ( p = 0.0013). Inverse probability of treatment weighting, which retained the whole cohort, gave a consistent estimate (hazard ratio [HR] 0.17, 95% confidence interval [CI] 0.08–0.39). Subgroup estimates were less precise in the low G8 group (HR 0.57, 95% CI 0.12–2.73) than in the intermediate (HR 0.14, 95% CI 0.06–0.33) and high (HR 0.10, 95% CI 0.02–0.39) groups. In sliding window analysis, HR estimates were higher at G8 < 9, with wide CIs. Similar results were observed for cancer‐specific survival. Conclusions RC was associated with a survival benefit in patients with intermediate and high G8 scores, whereas the evidence in the low G8 group was limited and inconclusive; careful risk–benefit evaluation remains warranted in this group.