Current status of management and outcomes of muscle-invasive bladder cancer in Yemen: a retrospective observational study

Background: The lack of a cohesive diagnostic and therapeutic framework for muscle-invasive bladder cancer (MIBC) in Yemen has resulted in significant variability in patient care. This study evaluates oncological outcomes and survival rates after radical cystectomy (RC) for MIBC patients in Yemen.
Methods: We conducted a retrospective analysis of 300 MIBC patients who underwent RC between 2006 and 2020. Demographics, histopathological findings, and survival data were meticulously collected. Kaplan-Meier survival analysis estimated survival probabilities, while prognostic factors were evaluated using the log-rank test.
Results: The median patient age was 67 years (IQR 65-70), with a male predominance (n=184, 61.3%). Ileal loop reconstruction was the primary method of urinary diversion (n=234, 78.0%). Urothelial carcinoma was the predominant diagnosis (n=246, 82.0%), followed by squamous cell carcinoma (n=42, 14.0%). Postoperative complications occurred in 93 patients (31.0%), primarily Grade I (n=61, 20.3%). Overall survival was 71.7% (n 215), with 28.3% mortality due to non-cancer-related (n=43, 14.3%) and bladder cancer-related causes (n=35, 11.7%). The median overall survival was 191 months, with 1-year, 3-year, 5-year, and 10-year survival rates of 99%, 93%, 88%, and 82%, respectively. In the multivariate analysis, non-ileal conduit diversion (Hazard Ratio [HR] 5.21, 95% Confidence Interval [CI]: 1.80-15.00, p=0.003), Stage IV disease (HR 2.76, 95% CI: 1.01-7.61, p=0.050), lymph node positivity (HR 2.92, 95% CI: 1.15-7.42, p=0.022), and squamous cell carcinoma (HR 3.09, 95% CI: 1.25-7.63, p=0.022) were identified as predictors of mortality.
Conclusions: This study highlights the urgent need for improved bladder cancer care in Yemen. Late-stage diagnosis and suboptimal surgical methods critically affect survival. Addressing these issues requires prioritizing early detection and standardized surgical techniques to develop effective care pathways for MIBC patients.

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