Prognostic Factors in Advanced Bladder Cancer: A Real-World Retrospective Analysis

Abstract

Introduction: Metastatic bladder cancer (mBC) is associated with poor outcomes. Despite advances in immunotherapy and targeted agents, platinum-based chemotherapy remains a cornerstone of treatment in real-world practice. We aimed to identify pragmatic and readily available prognostic factors for risk stratification in patients with mBC. Methods: This retrospective multicenter study included 121 patients with mBC treated at two high-volume oncology centers. Clinicopathological and laboratory parameters at the time of metastatic diagnosis were analyzed. The primary endpoint was overall survival (OS). Results: The median age was 66 years, and 90% of patients were male. The most common metastatic sites were abdominal lymph nodes (71.9%), bone (52.9%), lung (41.3%), and liver (27.3%). On multivariable analysis, Eastern Cooperative Oncology Group Performance Status ≥2 (hazard ratio [HR] 1.80 (1.04–3.14), p=0.036), low hemoglobin (HR 1.67 (1.01–2.77), p=0.046), hypoalbuminemia (HR 2.08 (1.24–3.50), p=0.006), and leukocytosis (HR 2.26 (1.32–3.87), p=0.003) were independently associated with inferior OS. Discussion and Conclusion: Poor performance status, low hemoglobin levels, hypoalbuminemia, and leukocytosis at metastatic diagnosis are independent predictors of worse survival. These simple, cost-effective parameters may support risk stratification and clinical decision-making, particularly in settings where access to novel therapies is limited.