Real-world outcomes of urothelial bladder cancer (UBC): A retrospective multicenter analysis from Peru.

Abstract

e23433 Background: Urothelial bladder cancer (UBC) outcomes in Latin America remain poorly characterized. Although incidence rates are lower than in Western countries, the disease is frequently diagnosed at advanced, muscle-invasive stages, and management is often affected by delayed diagnosis and limited access to specialized care. Real-world data describing survival outcomes and treatment patterns in Latin America (LATAM) are scarce. This study assessed real-world outcomes in a multicenter cohort of UBC patients from Peru. Methods: We conducted a retrospective multicenter cohort study including Peruvian patients with UBC treated at 6 institutions from 2015-2025. Recurrence- free survival (RFS, assessed among patients undergoing definitive surgery until first recurrence) and overall survival (OS) were analyzed by the Kaplan-Meier method and compared with log-rank test. A level of p < 0.05 was considered significant. Cox proportional hazards models were used for univariable and multivariable analyses. Results: 215 patients were included; median age was 71 years and 72% were male. Clinical stage distribution was as follows: stage I 19%, stage II 16%, stage III 46%, stage IVA 4%, and stage IVB 15%. Smoking history was documented in 8% of patients. 72% were muscle invasive bladder cancer (MIBC). Regarding medical treatment, neoadjuvant chemotherapy was administered to 10.7% of patients. Surgery was performed in 40.0% (n = 84), 5 recurrences (6%) were documented. Median follow-up for RFS was 23 months (1–80). 1-, 3- and 5-year RFS rates were 95%, 88%, and 88%, respectively. With a median follow-up of 18 months, 1-, 3- and 5-year OS rates were 62%, 39%, and 30%, respectively (median OS of 21 months). OS differed significantly according to multiple clinical characteristics, including histologic grade (p = 0.016), TNM classification (p < 0.001) and receipt of surgery (p < 0.001). In multivariable analysis, compared with stage I-II, stages III (HR 4.31, 2.25-8.24, p < 0.001) and IVB (HR 4.26, 2.07-8.77, p < 0.001) were the strongest predictors of mortality. OS was longer among patients who underwent surgery (median 42 vs 12 months, p = 0.001). No significant OS differences were observed according to neoadjuvant chemotherapy use, likely reflecting the limited number of treated patients. Conclusions: This study provides valuable real-world data on outcomes in patients with urothelial bladder cancer treated at multiple centers in Peru. Clinical stage at diagnosis was the primary determinant of overall survival; a high proportion presented with advanced stage (III-IV), likely contributing to short OS. The low utilization of neoadjuvant chemotherapy underscores important gaps between guideline recommendations and real-world practice, highlighting areas of unmet need and opportunities to improve access to curative-intent treatment in resource-limited settings.