Journal article
Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non-Muscle-Invasive Bladder Cancer
Journal of clinical oncology, Vol.44(4), pp.274-285
02/01/2026
DOI: 10.1200/JCO-25-01324
PMCID: PMC12707586
PMID: 41397208
Abstract
To compare patient-reported and clinical outcomes between radical cystectomy (RC) and bladder-sparing therapy (BST) in patients with recurrent high-grade non-muscle-invasive bladder cancer (NMIBC).
This pragmatic, prospective observational cohort study was designed with patients, who selected and prioritized outcomes. Eligible adults were candidates for both RC or BST, had previous induction Bacillus Calmette-Guérin (BCG), and received their last treatment within 12 months. The primary outcome was the EORTC-QLQ-C30 physical function scale at 12 months. Secondary outcomes included other EORTC-QLQ-C30 scales, depression, anxiety, bladder cancer-specific quality of life (QOL), financial burden, and cancer-specific outcomes. Targeted maximum likelihood estimation (TMLE) was used to calculate average treatment effect (ATE) estimates between arms. Inverse probability weighted risk ratios (wRR) were calculated using quasi-Poisson regression.
Of 570 participants (mean age 71.4 years; 21% female), 371 selected BST and 199 selected RC. Physical function was significantly worse in the RC arm at 3 months; by 9 months, there was no difference between arms, and at 12 months, physical function did not differ (ATE, 0.9; 95% CI, -0.6 to 2.4;
= .22). RC was associated with better emotional function, generic health-related QOL, and financial burden, and lower depression and anxiety, while BST was associated with better bowel and sexual health. Cancer-specific survival was 99% for BST versus 96% for RC (wRR, 0.99; 95% CI, 0.97 to 1.01). RC was associated with a higher risk of adverse events and serious adverse events, including a 90-day mortality rate of 2.5%.
Most patient-prioritized outcomes were similar or better among participants who chose RC compared with BST. These findings support the continued role of RC in managing recurrent high-grade NMIBC.
Details
- Title: Subtitle
- Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non-Muscle-Invasive Bladder Cancer
- Creators
- John L Gore - University of WashingtonErika M Wolff - University of WashingtonMichael G Nash - University of WashingtonBryan A Comstock - University of WashingtonScott M Gilbert - Moffitt Cancer CenterSam S Chang - Vanderbilt University Medical CenterStephanie Chisolm - Bladder Cancer Advocacy NetworkDouglas B MacLean - Advisory Board Company (United States)Jonathan L Wright - University of WashingtonMax R Kates - Johns Hopkins UniversityKamal S Pohar - The Ohio State UniversityThomas J Guzzo - University of PennsylvaniaTrinity J Bivalacqua - University of PennsylvaniaKenneth G Nepple - University of IowaJeffrey S Montgomery - Michigan MedicineKristen R Scarpato - Vanderbilt University Medical CenterSolomon L Woldu - The University of Texas Southwestern Medical CenterViraj A Master - Emory UniversityDavid Y T Chen - Fox Chase Cancer CenterMatthew Mossanen - Brigham and Women's HospitalSiamak Daneshmand - University of Southern CaliforniaBrock B O'Neil - Huntsman Cancer InstituteMark D Tyson - Mayo Clinic in ArizonaMary E Westerman - University of North Carolina at Chapel HillAshish M Kamat - The University of Texas MD Anderson Cancer CenterAhmed M Mansour - The University of Texas Health Science Center at San AntonioKarim Chamie - University of California, Los AngelesStephen B Riggs - Levine Cancer InstituteJanet B Kukreja - University of Colorado DenverParth K Modi - University of ChicagoTullika Garg - Geisinger Health SystemCharles C Peyton - University of AlabamaJeffrey W Nix - University of Alabama at BirminghamRian Dickstein - Chesapeake Urology AssociatesAdam J Gadzinski - Comprehensive UrologyAlex Sankin - Montefiore Medical CenterNeal D Shore - Carolina Urologic Research CenterBrian R Lane - Corewell HealthJeffrey C Bassett - Hoag Memorial Hospital PresbyterianDavid S Morris - Urology AssociatesSanjay Patel - University of Oklahoma Health Sciences CenterLiam C Macleod - Rogue Regional Medical CenterEugene K Lee - University of Kansas Medical CenterChad R Ritch - University of MiamiKristin M Follmer - University of WashingtonJenney R Lee - University of WashingtonSung Min Kim - University of WashingtonLarry G Kessler - University of WashingtonAngela B Smith - University of North Carolina at Chapel HillCISTO Collaborative group
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.44(4), pp.274-285
- DOI
- 10.1200/JCO-25-01324
- PMID
- 41397208
- PMCID
- PMC12707586
- NLM abbreviation
- J Clin Oncol
- ISSN
- 1527-7755
- eISSN
- 1527-7755
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- PCS-2017C3-9380 / Patient-Centered Outcomes Research Institute UL1 TR002319 / NCATS NIH HHS
- Language
- English
- Electronic publication date
- 12/15/2025
- Date published
- 02/01/2026
- Academic Unit
- Urology
- Record Identifier
- 9985091802402771
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