Factors Influencing Mortality of Metastatic Bladder Cancer: A Single-Center Experience

Objectives: Bladder cancer predominantly affects the elderly and exhibits poor survival in the metastatic stage, where the five-year survival rate is approximately 15% with contemporary regimens. Geriatric patients with metastatic bladder cancer generally have low-performance status and multiple comorbid diseases, therefore they often are unable to receive optimal therapy. We aimed to evaluate the rate of metastatic bladder cancer patients receiving systemic treatment, chemotherapy regimens, response to treatments, survival data, and factors influencing mortality. Methods: Patients with metastatic bladder cancer who were treated at our clinic between January 2011 and October 2021 were retrospectively reviewed. Factors affecting survival were evaluated using the long-rank test. Multivariate analysis was performed using cox regression. Results: A total of 121 patients with metastatic disease were included in the study. The median age of the patients was 68 (41-86) years. The median overall survival was 9 months. Overall one-, two- and five-year survival rates were 31%, 17%, and 0.5%, respectively. 52 (43%) of the patients died without receiving any systemic treatment at the metastatic stage. The median overall survival was 3.3 months in patients who received no systemic therapy at the metastatic stage, while it was 11.6 months in patients who received at least one line of therapy (p<0.01). The presence of liver metastasis (HR 1.9; %95 CI 1.17 to 3.09; p<0.01) and the absence of systemic treatment in the metastatic stage (HR 4.26; %95 CI 2.81 to 6.46; p<0.01) were among the independent risk factors for mortality. The rate of patients aged 65 and over was higher in the group not receiving chemotherapy (71.2% vs 47.8%, p=0.01). While 76.9% of the patients who did not receive chemotherapy had recurrent disease, this rate was 49.3% in the group receiving chemotherapy (p