Survival outcomes and prognostic factors in muscle-invasive bladder cancer: a retrospective cohort study from a Saudi Arabian tertiary center

Background: Bladder cancer (BC) exhibits a wide range of clinical behaviors, with survival outcomes depending on tumor biology, treatment choices, and patient characteristics. This study measured survival across different stages of the disease, compared the effectiveness of treatments, and identified prognostic factors in BC patients at a Tertiary Center.
Patients and Method: We reviewed 65 patients diagnosed with BC at the King Khaled Hospital in Najran, Saudi Arabia, from September 2014 to February 2025. Data on demographics, clinical presentation, pathology, treatment, and survival outcomes were collected. We used the Kaplan-Meier method to generate survival estimates and identified independent prognostic factors using multivariate Cox proportional hazards regression.
Results: The median overall survival (OS) was 23.4 months (95% confidence interval [CI], 19.8 to 27.1), with significant differences in survival based on disease stage: localized (median OS, 36 months; 95% CI, 30.2 to 41.8), locally advanced (22 months; 95% CI, 18.5 to 25.5), and metastatic (8 months; 95% CI, 6.2 to 9.8) (log-rank p < 0.001). The 1-year and 3-year OS rates were 72% (95% CI, 63–81%) and 41% (95% CI, 31–51%), respectively. Radical cystectomy provided the best survival outcomes (3-year OS, 64% compared to 38% for TURBT alone; adjusted hazard ratio [HR] 2.10, 95% CI 1.21 to 3.62). Multivariate analysis identified metastatic disease (adjusted hazard ratio [HR] 4.12, 95% CI 2.48 to 6.85), ECOG performance status ≥2 (HR 3.21, 95% CI 1.82 to 5.66), and lack of radical treatment (HR 1.97, 95% CI 1.19 to 3.27) as independent predictors of mortality.
Conclusions: Survival in BC is closely linked to disease stage, treatment type, and patient performance status. Radical cystectomy remains the main treatment for curing the disease, whereas cisplatin-based chemotherapy is the preferred option for advanced cases. These findings encourage personalized treatment strategies that consider performance status to improve outcomes.

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