{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:30:46Z","timestamp":1787499046827,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:00:00Z","timestamp":1713139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To perform a systematic review and meta\u2010analysis of trials comparing trimodal therapy (TMT) and radical cystectomy (RC), evaluating differences in terms of oncological outcomes, quality of life, and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In July 2023, a literature search of multiple databases was conducted to identify studies analysing patients with cT2\u20104\u2009N any M0 muscle\u2010invasive bladder cancer (MIBC; Patients) receiving TMT (Intervention) compared to RC (Comparison), to evaluate survival outcomes, recurrence rates, costs, and quality of life (Outcomes). The primary outcome was overall survival (OS). Secondary outcomes were cancer\u2010specific survival (CSS) and metastasis\u2010free survival (MFS). Hazard ratios (HRs) were used to analyse survival outcomes according to different treatment modalities and odds ratios were used to evaluate the likelihood of receiving each type of treatment according to T stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant difference in terms of OS was observed between RC and TMT (HR 1.07, 95% confidence interval [CI] 0.81\u20131.4;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.6), even when analysing radiation therapy regimens \u226560\u2009Gy (HR 1.02, 95% CI 0.69\u20131.52;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.9). No significant difference was observed in CSS (HR 1.12, 95% CI 0.79\u20131.57,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.5) or MFS (HR 0.88, 95% CI 0.66\u20131.16;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3). The mean cost of TMT was significantly higher than that of RC ($289\u2009142 vs $148\u2009757;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), with greater effectiveness in terms of cost per quality\u2010adjusted life\u2010year. TMT ensured significantly higher general quality\u2010of\u2010life scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Trimodal therapy appeared to yield comparable oncological outcomes to RC concerning OS, CSS and MFS, while providing superior patient quality of life and cost effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16366","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T02:24:38Z","timestamp":1713234278000},"page":"684-695","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Trimodal therapy vs radical cystectomy in patients with muscle\u2010invasive bladder cancer: a systematic review and meta\u2010analysis of comparative studies"],"prefix":"10.1111","volume":"134","author":[{"given":"Francesco","family":"Ditonno","sequence":"first","affiliation":[{"name":"Department of Urology Rush University Medical Center  Chicago IL USA"},{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5947-3206","authenticated-orcid":false,"given":"Alessandro","family":"Veccia","sequence":"additional","affiliation":[{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Montanaro","sequence":"additional","affiliation":[{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Pettenuzzo","sequence":"additional","affiliation":[{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Franco","sequence":"additional","affiliation":[{"name":"Department of Urology Rush University Medical Center  Chicago IL USA"},{"name":"Department of Urology, Sant'Andrea Hospital La Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Manfredi","sequence":"additional","affiliation":[{"name":"Department of Urology Rush University Medical Center  Chicago IL USA"},{"name":"Urology Unit, Department of Woman, Child and General and Specialized Surgery \u201cLuigi Vanvitelli\u201d University  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Triggiani","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University and Spedali Civili Hospital  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2190-512X","authenticated-orcid":false,"given":"Cosimo","family":"De Nunzio","sequence":"additional","affiliation":[{"name":"Department of Urology, Sant'Andrea Hospital La Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"De Sio","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Woman, Child and General and Specialized Surgery \u201cLuigi Vanvitelli\u201d University  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Cerruto","sequence":"additional","affiliation":[{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Crivellaro","sequence":"additional","affiliation":[{"name":"Department of Urology University of Illinois at Chicago  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kutikov","sequence":"additional","affiliation":[{"name":"Division of Urologic Oncology, Department of Surgical Oncology Fox Chase Cancer Center  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7045-7725","authenticated-orcid":false,"given":"Riccardo","family":"Autorino","sequence":"additional","affiliation":[{"name":"Department of Urology Rush University Medical Center  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7455-8803","authenticated-orcid":false,"given":"Alessandro","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Urology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,15]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"WitjesJA BruinsHM Carri\u00f3nAet\u00a0al.EAU guidelines on muscle\u2010invasive and metastatic bladder cancer [internet]. 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