AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.2024.0065
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RESEARCH ARTICLE

Neoadjuvant therapy plus thulium laser transurethral bladder tumor resection for muscle-invasive bladder cancer

Honglin Zhong1 ,  Wei He1 ,  Miao Mo1 ,  Shiyu Tong1 ,  Yinzhao Wang1 ,  Yuhang Wang1 ,  Xuhao Liu1 ,  Wenhao Zhu1 ,  Zhengchao Shen1 ,  Zhongfu Huang1 ,  Zhenyu Ou1†* ,  Minfeng Chen1†*
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1 Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
Bladder, e21200053 https://doi.org/10.14440/bladder.2024.0065
Submitted: 22 November 2024 | Revised: 11 February 2025 | Accepted: 25 April 2025 | Published: 5 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). However, its high perioperative mortality and significant impact on quality of life have led many patients to opt for bladder-preserving approaches, which currently lack a standardized treatment protocol. Objective: This study evaluated the efficacy and feasibility of bladder-preserving therapy using thulium laser maximal transurethral resection of bladder tumors (TURBT) combined with neoadjuvant therapy and immunotherapy in MIBC patients. Methods: A retrospective analysis was conducted on 46 MIBC patients treated with neoadjuvant therapy followed by thulium laser maximal TURBT at a single center between January 2021 and October 2024. Patients had received neoadjuvant immunotherapy in combination with chemotherapy or antibody-drug conjugate before maximal thulium laser TURBT. Those who achieved a complete clinical response were allowed to pursue either bladder preservation or RC. Patients choosing bladder-preserving therapy were either given maintenance immunotherapy or put on observation. Bladder-intact disease-free survival (BIDFS) was assessed through Kaplan–Meier analysis, and Cox regression identified factors influencing BIDFS. Results: Among the 46 patients, 95.7% remained alive, and 82.6% demonstrated no evidence of cancer with bladder function preserved. The estimated 2-year BIDFS rate was 84.2%, and T stage and maintenance immunotherapy were identified as two independent predictors of BIDFS. Patients receiving immunotherapy were at a significantly reduced risk of recurrence compared to their counterparts under observation. Conclusion: Thulium laser maximal TURBT, combined with neoadjuvant therapy and maintenance immunotherapy, is a promising bladder-preserving approach that helps MIBC patients attain favorable BIDFS and quality of life.

Keywords
Thulium
Muscle-invasive bladder cancer
Bladder preservation therapy
Transurethral resection of bladder tumor
Neoadjuvant therapy
Maintenance immunotherapy
Funding
This study was supported by the National Natural Science Foundation of China (82170789).
Conflict of interest
The authors declare that they have no conflicts of interest.
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